Provider Demographics
NPI:1962593491
Name:WOLF, JEFFERY BYRON (DC)
Entity type:Individual
Prefix:
First Name:JEFFERY
Middle Name:BYRON
Last Name:WOLF
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 1:2610 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847
Mailing Address - Country:US
Mailing Address - Phone:308-236-7772
Mailing Address - Fax:308-234-2053
Practice Address - Street 1:2610 2ND AVE
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847
Practice Address - Country:US
Practice Address - Phone:308-236-7772
Practice Address - Fax:308-234-2053
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE887111N00000X
WY421111N00000X
MT513111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47080048800Medicaid
NE36606OtherBLUE CROSS BLUE SHIELD
NE267750W0Medicare ID - Type Unspecified
NE47080048800Medicaid