Provider Demographics
NPI:1245342252
Name:WACHHOLZ, PAMELA MARIE (DC)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:MARIE
Last Name:WACHHOLZ
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 1:1284 E. LATHAM AVE
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543
Mailing Address - Country:US
Mailing Address - Phone:951-652-4357
Mailing Address - Fax:951-658-6657
Practice Address - Street 1:1284 E. LATHAM AVE
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543
Practice Address - Country:US
Practice Address - Phone:951-652-4357
Practice Address - Fax:951-658-6657
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC21158111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor