Provider Demographics
NPI:1124156344
Name:WOLFF, RYAN P (DC)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:P
Last Name:WOLFF
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1202 MAIN ST NE
Mailing Address - Street 2:SUITE C
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-7409
Mailing Address - Country:US
Mailing Address - Phone:505-866-1226
Mailing Address - Fax:505-480-7791
Practice Address - Street 1:1202 MAIN ST NE
Practice Address - Street 2:SUITE C
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-7409
Practice Address - Country:US
Practice Address - Phone:505-866-1226
Practice Address - Fax:505-480-7791
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1483111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM260676Medicare PIN