Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 9580 | TX |
Y | 111NS0005X | Chiropractic Sports Physician | 9580 | TX |
NPI | 1144305525 |
---|---|
Provider Name | Dr. Michael David Wolford |
First Address | Houston, TX 77070-1557 |
Second Address | Houston, TX 77070 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2006 |
Last Update Date | 04/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
608457 | BLUE CROSS BLUE SHIELD (01) | TX |