Provider Demographics
NPI:1063697464
Name:WOLF CHIROPRACTIC CENTER PS INC
Entity type:Organization
Organization Name:WOLF CHIROPRACTIC CENTER PS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEANINE
Authorized Official - Middle Name:J
Authorized Official - Last Name:WOLF-RICHTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:253-838-7300
Mailing Address - Street 1:622 S 320TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-5263
Mailing Address - Country:US
Mailing Address - Phone:206-818-6870
Mailing Address - Fax:253-838-0505
Practice Address - Street 1:622 S 320TH ST STE B
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-5263
Practice Address - Country:US
Practice Address - Phone:206-818-6870
Practice Address - Fax:253-838-0505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2631111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8801731Medicare PIN