Provider Demographics
NPI:1932297397
Name:CHIROPRACTIC CARE PAMELA M WACHHOLZ INC
Entity Type:Organization
Organization Name:CHIROPRACTIC CARE PAMELA M WACHHOLZ INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WACHHOLZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:951-652-4357
Mailing Address - Street 1:760 W ACACIA AVE
Mailing Address - Street 2:SUITE 113
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-4081
Mailing Address - Country:US
Mailing Address - Phone:951-652-4357
Mailing Address - Fax:951-658-6657
Practice Address - Street 1:760 W ACACIA AVE
Practice Address - Street 2:SUITE 113
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-4081
Practice Address - Country:US
Practice Address - Phone:951-652-4357
Practice Address - Fax:951-658-6657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC21158111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0211580Medicaid
CADC0211580Medicaid