1134221310 NPI number — WOLFE CHIROPRACTIC CENTER PC

Table of content: (NPI 1134221310)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134221310 NPI number — WOLFE CHIROPRACTIC CENTER PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WOLFE CHIROPRACTIC CENTER PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134221310
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8001 RAINTREE LN
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28277-8920
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-837-7131
Provider Business Mailing Address Fax Number:
704-542-6552

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8001 RAINTREE LN
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28277-8920
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-837-7131
Provider Business Practice Location Address Fax Number:
704-542-6552
Provider Enumeration Date:
09/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WOLFE
Authorized Official First Name:
EDWARD
Authorized Official Middle Name:
F.X.
Authorized Official Title or Position:
CHIROPRACTIC PHYSICIAN
Authorized Official Telephone Number:
704-837-7131

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  2946 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 804246 . This is a "PARTNERS MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 085GG . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 89085GG , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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