Healthcare Provider Details

I. General information

NPI: 1750576203
Provider Name (Legal Business Name): MICHAEL PATRICK WOHLMAKER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2007
Last Update Date: 12/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22110 ROSCOE BLVD # 304
WEST HILLS CA
91304-3845
US

IV. Provider business mailing address

17427 SEPTO ST
NORTHRIDGE CA
91325-1531
US

V. Phone/Fax

Practice location:
  • Phone: 818-901-0405
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC30263
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: