Individual
ANDREW DEWOLF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1025 E 7TH ST, BLOOMINGTON, IN 47405-7109
(503) 476-6989
Mailing address
1861 S PECAN LN, BLOOMINGTON, IN 47403-3258
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2000014569
OR
Other
Enumeration date
10/23/2014
Last updated
10/23/2014
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