Provider Demographics
NPI:1356670442
Name:WOHLRABE CHIROPRACTIC & ACUPUNCTURE, P.A.
Entity Type:Organization
Organization Name:WOHLRABE CHIROPRACTIC & ACUPUNCTURE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WOHLRABE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:507-639-2002
Mailing Address - Street 1:11 CHESTNUT ST E
Mailing Address - Street 2:P.O. BOX L
Mailing Address - City:TRIMONT
Mailing Address - State:MN
Mailing Address - Zip Code:56176-9678
Mailing Address - Country:US
Mailing Address - Phone:507-639-2002
Mailing Address - Fax:
Practice Address - Street 1:11 CHESTNUT ST E
Practice Address - Street 2:P.O. BOX L
Practice Address - City:TRIMONT
Practice Address - State:MN
Practice Address - Zip Code:56176-9678
Practice Address - Country:US
Practice Address - Phone:507-639-2002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-18
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1935111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
3590000121OtherWPS MEDICARE PART B
MN844727600Medicaid
OG496-WOOtherBLUE CROSS BLUE SHIELD OF MINNESOTA
350031718OtherPALMETTO GBA
350031718OtherPALMETTO GBA
3590000121OtherWPS MEDICARE PART B