Provider Demographics
NPI:1174558902
Name:WOLF, PAUL S (DC)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:S
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 1:260 S HALCYON RD
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-3135
Mailing Address - Country:US
Mailing Address - Phone:805-473-2200
Mailing Address - Fax:805-481-6950
Practice Address - Street 1:260 S HALCYON RD
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-3135
Practice Address - Country:US
Practice Address - Phone:805-473-2200
Practice Address - Fax:805-481-6950
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27566111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0275660Medicare ID - Type Unspecified