Healthcare Provider Details

I. General information

NPI: 1881610509
Provider Name (Legal Business Name): DALE LYNN WOHLRABE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 08/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 W LAWRENCE AVE SUITE J-4
SPRINGFIELD IL
62704-1181
US

IV. Provider business mailing address

2700 W LAWRENCE AVE SUITE J-4
SPRINGFIELD IL
62704-1181
US

V. Phone/Fax

Practice location:
  • Phone: 271-546-6698
  • Fax: 217-546-4487
Mailing address:
  • Phone: 271-546-6698
  • Fax: 217-546-4487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1935
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038.011817
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: