Healthcare Provider Details

I. General information

NPI: 1497888598
Provider Name (Legal Business Name): RICHARD V. AUSTIN,D.C.,A PROFESSIONAL CHIROPRACTIC CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 12/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 11TH ST
RAMONA CA
92065-3912
US

IV. Provider business mailing address

414 11TH ST P.O. BOX 507
RAMONA CA
92065-3912
US

V. Phone/Fax

Practice location:
  • Phone: 760-789-3864
  • Fax: 760-789-3888
Mailing address:
  • Phone: 760-789-3864
  • Fax: 760-789-3888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC11399
License Number StateCA

VIII. Authorized Official

Name: RICHARD VANCE AUSTIN
Title or Position: PRESIDENT
Credential: D.C.
Phone: 760-789-3864