Provider Demographics
NPI:1750431474
Name:WOLF, GINA M (DC)
Entity type:Individual
Prefix:DR
First Name:GINA
Middle Name:M
Last Name:WOLF
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:M
Other - Last Name:TRAUTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15404 E SPRINGFIELD AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99037-8569
Mailing Address - Country:US
Mailing Address - Phone:509-892-9800
Mailing Address - Fax:509-892-9998
Practice Address - Street 1:15404 E SPRINGFIELD AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99037-8569
Practice Address - Country:US
Practice Address - Phone:509-892-9800
Practice Address - Fax:509-892-9998
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002966111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0193196OtherLABOR & INDUSTRIES
8851738Medicare ID - Type Unspecified
48444Medicare UPIN