Provider Demographics
NPI:1003113259
Name:AHEARN, IAN PHILIPE (DC)
Entity Type:Individual
Prefix:DR
First Name:IAN
Middle Name:PHILIPE
Last Name:AHEARN
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 1:3065 ROSECRANS PL STE 108
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-4854
Mailing Address - Country:US
Mailing Address - Phone:619-640-0321
Mailing Address - Fax:619-435-3158
Practice Address - Street 1:3065 ROSECRANS PL STE 108
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-4854
Practice Address - Country:US
Practice Address - Phone:619-640-0321
Practice Address - Fax:619-435-3158
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-24
Last Update Date:2020-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32020111NS0005X, 111N00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA32020OtherLICENSE