Provider Demographics
NPI:1992907976
Name:AUSSERBAUER, WOLFGANG WAYNE (DC)
Entity type:Individual
Prefix:DR
First Name:WOLFGANG
Middle Name:WAYNE
Last Name:AUSSERBAUER
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 1:1206 COAST VILLAGE CIR
Mailing Address - Street 2:SUITE F
Mailing Address - City:MONTECITO
Mailing Address - State:CA
Mailing Address - Zip Code:93108-2710
Mailing Address - Country:US
Mailing Address - Phone:805-565-0770
Mailing Address - Fax:
Practice Address - Street 1:1206 COAST VILLAGE CIR
Practice Address - Street 2:SUITE F
Practice Address - City:MONTECITO
Practice Address - State:CA
Practice Address - Zip Code:93108-2710
Practice Address - Country:US
Practice Address - Phone:805-565-0770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14670111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC014700Medicare ID - Type Unspecified