Provider Demographics
NPI:1932230935
Name:WAHLRAB, RIK MICHAEL (DC)
Entity Type:Individual
Prefix:
First Name:RIK
Middle Name:MICHAEL
Last Name:WAHLRAB
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25272 MCINTYRE ST STE H
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-5449
Mailing Address - Country:US
Mailing Address - Phone:949-207-4935
Mailing Address - Fax:
Practice Address - Street 1:25272 MCINTYRE ST STE H
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-5449
Practice Address - Country:US
Practice Address - Phone:949-207-4935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC16924111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC16924AOtherPTAN
CADC0169240OtherBLUE SHIELD
CADC16924OtherCHIROPRACTIC LICENSE