Provider Demographics
NPI:1407952146
Name:DAHLIN, STEPHEN (DC)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:DAHLIN
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:PO BOX 970
Mailing Address - Street 2:
Mailing Address - City:COARSEGOLD
Mailing Address - State:CA
Mailing Address - Zip Code:93614-0970
Mailing Address - Country:US
Mailing Address - Phone:559-683-6292
Mailing Address - Fax:559-683-4742
Practice Address - Street 1:35234 HIGHWAY 41
Practice Address - Street 2:STE. 1
Practice Address - City:COARSEGOLD
Practice Address - State:CA
Practice Address - Zip Code:93614-8745
Practice Address - Country:US
Practice Address - Phone:559-683-6292
Practice Address - Fax:559-683-4742
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24325111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU65804Medicare UPIN
CADC0243250Medicare ID - Type Unspecified