Provider Demographics
NPI:1811092091
Name:WULF, LANCE ALBERT (DC)
Entity type:Individual
Prefix:DR
First Name:LANCE
Middle Name:ALBERT
Last Name:WULF
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 1:601 S 32ND AVE
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-3958
Mailing Address - Country:US
Mailing Address - Phone:715-848-2526
Mailing Address - Fax:715-848-2225
Practice Address - Street 1:215 N BLACK RIVER ST
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:WI
Practice Address - Zip Code:54656-1529
Practice Address - Country:US
Practice Address - Phone:608-269-4511
Practice Address - Fax:608-269-8511
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4102111N00000X
MN4663111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN051H2WUOtherBLUE CROSS BLUE SHEILD
WI201803724OtherUNITED HEALTH CARE
WI38958900Medicaid
WI5605960001OtherMEDICARE DMEPOS
MN966462900OtherMCARE OF MINNESOTA
WI2018037247OtherWPS
WI201803724OtherUNITED HEALTH CARE
MN966462900OtherMCARE OF MINNESOTA