Provider Demographics
NPI:1841206729
Name:WOLF, ROBERT HUGH (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:HUGH
Last Name:WOLF
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 1:2960 ST ROSE PARKWAY #150
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052
Mailing Address - Country:US
Mailing Address - Phone:702-617-4598
Mailing Address - Fax:818-880-6689
Practice Address - Street 1:2960 ST ROSE PARKWAY #150
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052
Practice Address - Country:US
Practice Address - Phone:702-617-4598
Practice Address - Fax:818-880-6689
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB01808111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0007537731Medicare UPIN
CADC17857Medicare ID - Type Unspecified