Provider Demographics
NPI:1619055613
Name:PROESCHOLDT, KAREN ANNE (DC)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:ANNE
Last Name:PROESCHOLDT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 E CHAPMAN AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92866-2110
Mailing Address - Country:US
Mailing Address - Phone:714-639-4655
Mailing Address - Fax:714-639-1633
Practice Address - Street 1:1025 E CHAPMAN AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92866-2110
Practice Address - Country:US
Practice Address - Phone:714-639-4655
Practice Address - Fax:714-639-1633
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 20354111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU46102Medicare UPIN
CA20354Medicare ID - Type Unspecified