Provider Demographics
NPI:1841489044
Name:WOLPH CHIROPRACTIC, INC.
Entity type:Organization
Organization Name:WOLPH CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLAY
Authorized Official - Middle Name:W
Authorized Official - Last Name:WOLPH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:419-436-0616
Mailing Address - Street 1:123 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FOSTORIA
Mailing Address - State:OH
Mailing Address - Zip Code:44830-2309
Mailing Address - Country:US
Mailing Address - Phone:419-436-0616
Mailing Address - Fax:419-435-1622
Practice Address - Street 1:123 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FOSTORIA
Practice Address - State:OH
Practice Address - Zip Code:44830-2309
Practice Address - Country:US
Practice Address - Phone:419-436-0616
Practice Address - Fax:419-435-1622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1859111N00000X
OH2342111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0888491Medicaid
OH0230539Medicaid
OHV10489Medicare UPIN
OHW04195581Medicare PIN
OH0888491Medicaid
OHU34748Medicare UPIN
OH0230539Medicaid