Provider Demographics
NPI:1972621696
Name:WOLF, BRAD ALAN (DC)
Entity type:Individual
Prefix:
First Name:BRAD
Middle Name:ALAN
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 1:2136 GALLOWS RD STE A
Mailing Address - Street 2:
Mailing Address - City:DUNN LORING
Mailing Address - State:VA
Mailing Address - Zip Code:22027-1036
Mailing Address - Country:US
Mailing Address - Phone:703-204-2320
Mailing Address - Fax:703-204-1618
Practice Address - Street 1:2136 GALLOWS RD STE A
Practice Address - Street 2:
Practice Address - City:DUNN LORING
Practice Address - State:VA
Practice Address - Zip Code:22027-1036
Practice Address - Country:US
Practice Address - Phone:703-204-2320
Practice Address - Fax:703-204-1618
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1747111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor