Provider Demographics
NPI:1386754539
Name:WOLFF, MARK R (DC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:R
Last Name:WOLFF
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 1:9130 W LOOMIS RD STE 900
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-9098
Mailing Address - Country:US
Mailing Address - Phone:414-425-9609
Mailing Address - Fax:
Practice Address - Street 1:9130 W LOOMIS RD STE 900
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132-9098
Practice Address - Country:US
Practice Address - Phone:414-425-9609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2023-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2397-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIT83397Medicare UPIN
WI000075962Medicare ID - Type Unspecified