Provider Demographics
NPI:1801884630
Name:WULFERT, TIMOTHY L (DC)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:L
Last Name:WULFERT
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:PO BOX 242
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-0242
Mailing Address - Country:US
Mailing Address - Phone:573-756-9292
Mailing Address - Fax:573-756-9292
Practice Address - Street 1:1036 E KARSCH BLVD
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-3403
Practice Address - Country:US
Practice Address - Phone:573-756-9292
Practice Address - Fax:573-756-9292
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCE 005766111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2890OtherBCBS
MO253775OtherHEALTHLINK HMO PPO
MO253775OtherHEALTHLINK HMO PPO
MO31357Medicare ID - Type UnspecifiedMEDICARE PROVIDER #