Healthcare Provider Details

I. General information

NPI: 1083744569
Provider Name (Legal Business Name): RICHARD MONSOUR D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 09/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8343 CHURCH ST # D
GILROY CA
95020-4406
US

IV. Provider business mailing address

7598 MONTEREY ST STE 130
GILROY CA
95020-5869
US

V. Phone/Fax

Practice location:
  • Phone: 408-848-6454
  • Fax:
Mailing address:
  • Phone: 408-848-6454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number16643
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: