Provider Demographics
NPI:1225177561
Name:WULBERN, RICHARD HENRY IV (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:HENRY
Last Name:WULBERN
Suffix:IV
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 1:2335 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95966-5329
Mailing Address - Country:US
Mailing Address - Phone:530-534-3590
Mailing Address - Fax:530-534-1831
Practice Address - Street 1:2335 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95966-5329
Practice Address - Country:US
Practice Address - Phone:530-534-3590
Practice Address - Fax:530-534-1831
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26828111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MMM00203MMedicare ID - Type Unspecified
U95251Medicare UPIN