Provider Demographics
NPI:1861552499
Name:WIEDERRICH, HANS ORRIN (DC)
Entity type:Individual
Prefix:
First Name:HANS
Middle Name:ORRIN
Last Name:WIEDERRICH
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 1:14103 POWAY RD
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-4926
Mailing Address - Country:US
Mailing Address - Phone:858-748-4343
Mailing Address - Fax:858-748-4881
Practice Address - Street 1:14103 POWAY RD
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-4926
Practice Address - Country:US
Practice Address - Phone:858-748-4343
Practice Address - Fax:858-748-4881
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23611111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWDC23611BMedicare ID - Type Unspecified
CAU69600Medicare UPIN