Provider Demographics
NPI:1013918689
Name:WOLFE, RICHARD D (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:D
Last Name:WOLFE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1169 HIGHWAY 70 E
Mailing Address - Street 2:
Mailing Address - City:DE QUEEN
Mailing Address - State:AR
Mailing Address - Zip Code:71832-8008
Mailing Address - Country:US
Mailing Address - Phone:870-642-4050
Mailing Address - Fax:870-642-4059
Practice Address - Street 1:1169 HIGHWAY 70 E
Practice Address - Street 2:
Practice Address - City:DE QUEEN
Practice Address - State:AR
Practice Address - Zip Code:71832-8008
Practice Address - Country:US
Practice Address - Phone:870-642-4050
Practice Address - Fax:870-642-4059
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2008-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1254111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR59821OtherBLUE CROSS BLUE SHIELD ID
AR59821Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER