Provider Demographics
NPI:1780725861
Name:WOLF, CARRIE M (DC)
Entity type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:M
Last Name:WOLF
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19753 E. PIKES PEAK CT.
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138
Mailing Address - Country:US
Mailing Address - Phone:303-840-4991
Mailing Address - Fax:303-840-1945
Practice Address - Street 1:19753 E. PIKES PEAK CT.
Practice Address - Street 2:STE. 101
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138
Practice Address - Country:US
Practice Address - Phone:303-840-4991
Practice Address - Fax:303-840-1945
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3411111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCO01057Medicare ID - Type Unspecified
COC29643Medicare ID - Type Unspecified