Provider Demographics
NPI:1578824025
Name:WIKOFF CHIROPRACTIC, INC.
Entity type:Organization
Organization Name:WIKOFF CHIROPRACTIC, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:WIKOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:1714-541-5433
Mailing Address - Street 1:2431 N TUSTIN AVE STE A
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-1660
Mailing Address - Country:US
Mailing Address - Phone:714-541-5433
Mailing Address - Fax:714-541-5405
Practice Address - Street 1:2431 N TUSTIN AVE STE A
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-1660
Practice Address - Country:US
Practice Address - Phone:714-541-5433
Practice Address - Fax:714-541-5405
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WIKOFF CHIROPRACTIC, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-05-31
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22211111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC22211Medicare UPIN