Provider Demographics
NPI:1356671341
Name:WOLFRAM, JOSHUA ROBERT (DC)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:ROBERT
Last Name:WOLFRAM
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 1:4356 COMMERCIAL ST SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-3914
Mailing Address - Country:US
Mailing Address - Phone:503-689-1216
Mailing Address - Fax:503-689-1520
Practice Address - Street 1:4356 COMMERCIAL ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-3914
Practice Address - Country:US
Practice Address - Phone:503-383-9375
Practice Address - Fax:503-689-1520
Is Sole Proprietor?:No
Enumeration Date:2010-01-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3989111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor