Provider Demographics
NPI:1134221310
Name:WOLFE CHIROPRACTIC CENTER PC
Entity type:Organization
Organization Name:WOLFE CHIROPRACTIC CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:FX
Authorized Official - Last Name:WOLFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-837-7131
Mailing Address - Street 1:8001 RAINTREE LN
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-8920
Mailing Address - Country:US
Mailing Address - Phone:704-837-7131
Mailing Address - Fax:704-542-6552
Practice Address - Street 1:8001 RAINTREE LN
Practice Address - Street 2:SUITE 100
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-8920
Practice Address - Country:US
Practice Address - Phone:704-837-7131
Practice Address - Fax:704-542-6552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2008-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2946111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC804246OtherPARTNERS MEDICARE
NC085GGOtherBCBS
NC89085GGMedicaid
NC085GGOtherBCBS
NC804246OtherPARTNERS MEDICARE