Provider Demographics
NPI:1427046747
Name:WOLFF, ROBERT JOHN (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JOHN
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 1:3720 WILBARGER ST
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:TX
Mailing Address - Zip Code:76384-3287
Mailing Address - Country:US
Mailing Address - Phone:940-552-9951
Mailing Address - Fax:940-552-2382
Practice Address - Street 1:3720 WILBARGER ST
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:TX
Practice Address - Zip Code:76384-3259
Practice Address - Country:US
Practice Address - Phone:940-552-9951
Practice Address - Fax:940-552-2382
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC4310111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00313096-01Medicaid
TX8M5954OtherBLUE CROSS BLUE SHIELD OF
TX601636Medicare PIN
TX8M5954OtherBLUE CROSS BLUE SHIELD OF