Provider Demographics
NPI:1396918934
Name:WAHL, IAN JEFFREY (DAC, LAC, CH)
Entity type:Individual
Prefix:DR
First Name:IAN
Middle Name:JEFFREY
Last Name:WAHL
Suffix:
Gender:M
Credentials:DAC, LAC, CH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3375 N ARLINGTON HEIGHTS RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-7701
Mailing Address - Country:US
Mailing Address - Phone:847-392-7901
Mailing Address - Fax:847-392-7921
Practice Address - Street 1:3375 N ARLINGTON HEIGHTS RD
Practice Address - Street 2:SUITE A
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-7701
Practice Address - Country:US
Practice Address - Phone:847-392-7901
Practice Address - Fax:847-392-7921
Is Sole Proprietor?:No
Enumeration Date:2008-04-03
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198.000535171100000X
RIDA00288171100000X
WI452005171100000X
AZ0454171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist