Provider Demographics
NPI:1770627291
Name:DAHL, EVA (DC,OTR)
Entity Type:Individual
Prefix:DR
First Name:EVA
Middle Name:
Last Name:DAHL
Suffix:
Gender:F
Credentials:DC,OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 BRIDGEWAY STE 200
Mailing Address - Street 2:
Mailing Address - City:SAUSALITO
Mailing Address - State:CA
Mailing Address - Zip Code:94965-2851
Mailing Address - Country:US
Mailing Address - Phone:415-331-8851
Mailing Address - Fax:415-331-9683
Practice Address - Street 1:2400 BRIDGEWAY STE 200
Practice Address - Street 2:
Practice Address - City:SAUSALITO
Practice Address - State:CA
Practice Address - Zip Code:94965-2851
Practice Address - Country:US
Practice Address - Phone:415-331-8851
Practice Address - Fax:415-331-9683
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21286111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor