Healthcare Provider Details

I. General information

NPI: 1659596419
Provider Name (Legal Business Name): RICKARD CHIROPRACTIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 10/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1862 GREEN MEADOW LN
MEADOW VISTA CA
95722-9403
US

IV. Provider business mailing address

1862 GREEN MEADOW LN
MEADOW VISTA CA
95722-9403
US

V. Phone/Fax

Practice location:
  • Phone: 530-392-3009
  • Fax:
Mailing address:
  • Phone: 530-392-3009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC913
License Number StateHI

VIII. Authorized Official

Name: STEPHEN CHARLES RICKARD
Title or Position: PRESIDENT
Credential: D.C.
Phone: 808-887-1918