Provider Demographics
NPI:1720165384
Name:WULFF, JOEL B (DC)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:B
Last Name:WULFF
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 1:9678 COLORADO LANE NORTH
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55445
Mailing Address - Country:US
Mailing Address - Phone:763-391-9484
Mailing Address - Fax:763-391-9425
Practice Address - Street 1:9678 COLORADO LANE NORTH
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55445
Practice Address - Country:US
Practice Address - Phone:763-391-9484
Practice Address - Fax:763-391-9425
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2692111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN4C708CHOtherBCBS
MN4C708WUOtherCHIROCARE
MN4C708WUOtherCHIROCARE
MN877-908-8470Medicare ID - Type Unspecified