Provider Demographics
NPI:1487736765
Name:MAHER, VENUS ANN (DC)
Entity type:Individual
Prefix:DR
First Name:VENUS
Middle Name:ANN
Last Name:MAHER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 GOLF COURSE DR
Mailing Address - Street 2:C5
Mailing Address - City:ROHNERT PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94928
Mailing Address - Country:US
Mailing Address - Phone:707-792-0202
Mailing Address - Fax:707-792-2056
Practice Address - Street 1:101 GOLF COURSE DR
Practice Address - Street 2:C5
Practice Address - City:ROHNERT PARK
Practice Address - State:CA
Practice Address - Zip Code:94928
Practice Address - Country:US
Practice Address - Phone:707-792-0202
Practice Address - Fax:707-792-2056
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 0182480111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA350040350OtherRAILROAD MEDICARE PTAN
CADC 0182480OtherSTATE LICENCE
CAU30695Medicare UPIN
CADC0182480Medicare PIN