Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 1607 | CO |
NPI | 1285739920 |
---|---|
Provider Name | Dr. Mark M. Wolff |
First Address | Lakewood, CO 80226-1565 |
Second Address | Lakewood, CO 80226-1565 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2006 |
Last Update Date | 01/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T60507 | (02) | CO |