Provider Demographics
NPI:1326543075
Name:WOLFERT, BLAIR ANN-BRESLIN (DC)
Entity type:Individual
Prefix:DR
First Name:BLAIR
Middle Name:ANN-BRESLIN
Last Name:WOLFERT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:BLAIR
Other - Middle Name:ANN
Other - Last Name:BRESLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:11219 BROWN AVE
Mailing Address - Street 2:
Mailing Address - City:ALLENDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49401-9405
Mailing Address - Country:US
Mailing Address - Phone:616-379-9329
Mailing Address - Fax:616-379-9329
Practice Address - Street 1:11219 BROWN AVE
Practice Address - Street 2:
Practice Address - City:ALLENDALE
Practice Address - State:MI
Practice Address - Zip Code:49401-9405
Practice Address - Country:US
Practice Address - Phone:616-379-9329
Practice Address - Fax:616-379-9329
Is Sole Proprietor?:No
Enumeration Date:2018-03-26
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4299111N00000X
MI2301010652111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor