Provider Demographics
NPI:1699898684
Name:RAWLINSON, IAN ROBERT (LICAC)
Entity type:Individual
Prefix:
First Name:IAN
Middle Name:ROBERT
Last Name:RAWLINSON
Suffix:
Gender:M
Credentials:LICAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 D ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-3006
Mailing Address - Country:US
Mailing Address - Phone:707-762-4309
Mailing Address - Fax:
Practice Address - Street 1:405 D ST
Practice Address - Street 2:SUITE 1
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-3006
Practice Address - Country:US
Practice Address - Phone:707-762-4309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2573171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist