Provider Demographics
NPI:1962425066
Name:WOLPH, CLAY WESLEY (DC)
Entity type:Individual
Prefix:MR
First Name:CLAY
Middle Name:WESLEY
Last Name:WOLPH
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 1:123 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FOSTORIA
Mailing Address - State:OH
Mailing Address - Zip Code:44830
Mailing Address - Country:US
Mailing Address - Phone:419-436-0616
Mailing Address - Fax:419-435-1622
Practice Address - Street 1:123 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FOSTORIA
Practice Address - State:OH
Practice Address - Zip Code:44830
Practice Address - Country:US
Practice Address - Phone:419-436-0616
Practice Address - Fax:419-435-1622
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2342111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0230539Medicaid
OHW04185582Medicare PIN
OH0230539Medicaid
OHW04195581Medicare PIN