Provider Demographics
NPI:1932237641
Name:WOLFE CHIROPRACTIC CLINIC, P.A.
Entity Type:Organization
Organization Name:WOLFE CHIROPRACTIC CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:WOLFE
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:281-592-6757
Mailing Address - Street 1:200 E HOUSTON ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TX
Mailing Address - Zip Code:77327-4512
Mailing Address - Country:US
Mailing Address - Phone:281-592-6757
Mailing Address - Fax:
Practice Address - Street 1:200 E HOUSTON ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TX
Practice Address - Zip Code:77327-4512
Practice Address - Country:US
Practice Address - Phone:281-592-6757
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7362111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX605773OtherBLUE CROSS & BLUE SHIELD
TX609015Medicare ID - Type UnspecifiedMEDICARE