Provider Demographics
NPI:1457732240
Name:MARK WOLFF, DC, LLC
Entity Type:Organization
Organization Name:MARK WOLFF, DC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLFF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-985-5122
Mailing Address - Street 1:215 S WADSWORTH BLVD STE 420
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-1566
Mailing Address - Country:US
Mailing Address - Phone:303-986-5122
Mailing Address - Fax:
Practice Address - Street 1:215 S WADSWORTH BLVD STE 420
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-1566
Practice Address - Country:US
Practice Address - Phone:303-986-5122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-17
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1607111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC14503Medicare PIN
COT60507Medicare UPIN