Provider Demographics
NPI:1104697762
Name:WOLVERTON, ZACHARY WILLIAM (DC)
Entity type:Individual
Prefix:MR
First Name:ZACHARY
Middle Name:WILLIAM
Last Name:WOLVERTON
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:P.O. BOX 8918
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-8918
Mailing Address - Country:US
Mailing Address - Phone:215-782-3891
Mailing Address - Fax:215-224-2020
Practice Address - Street 1:7172 OGONTZ AVENUE
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19138-1942
Practice Address - Country:US
Practice Address - Phone:267-672-1260
Practice Address - Fax:215-613-7676
Is Sole Proprietor?:No
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011892111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor