Healthcare Provider Details

I. General information

NPI: 1508175753
Provider Name (Legal Business Name): RICHETTO CHIROPRACTIC AND REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2010
Last Update Date: 01/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37852 N BEVERLY AVE
QUEEN CREEK AZ
85140-4186
US

IV. Provider business mailing address

37852 N BEVERLY AVE
QUEEN CREEK AZ
85140-4186
US

V. Phone/Fax

Practice location:
  • Phone: 480-775-3503
  • Fax: 480-775-3508
Mailing address:
  • Phone: 480-775-3503
  • Fax: 480-775-3508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number7378
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number4562
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number4562PT
License Number StateAZ

VIII. Authorized Official

Name: DR. PAUL ANDREW RICHETTO
Title or Position: CHIEF TREATING PHYSICIAN
Credential: D.C.
Phone: 480-775-3503