Provider Demographics
NPI:1881610509
Name:WOHLRABE, DALE LYNN (DC)
Entity type:Individual
Prefix:DR
First Name:DALE
Middle Name:LYNN
Last Name:WOHLRABE
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 1:2700 W LAWRENCE AVE
Mailing Address - Street 2:SUITE J-4
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-1181
Mailing Address - Country:US
Mailing Address - Phone:271-546-6698
Mailing Address - Fax:217-546-4487
Practice Address - Street 1:2700 W LAWRENCE AVE
Practice Address - Street 2:SUITE J-4
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-1181
Practice Address - Country:US
Practice Address - Phone:271-546-6698
Practice Address - Fax:217-546-4487
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1935111N00000X
IL038.011817111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN359000121Medicare ID - Type Unspecified
MNC39751Medicare UPIN
MN22197OtherSOUIX VALLEY HEALTH PLAN
MN0290OtherHSM PROVIDER #
MNC39751Medicare UPIN