Healthcare Provider Details

I. General information

NPI: 1760556690
Provider Name (Legal Business Name): RONALD CALLIS HERBERT D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3730 PONTIAC AVE
RIVERSIDE CA
92509-4439
US

IV. Provider business mailing address

2275 RORIMER DR
RIVERSIDE CA
92509-1654
US

V. Phone/Fax

Practice location:
  • Phone: 951-683-4935
  • Fax: 951-684-1551
Mailing address:
  • Phone: 951-685-6556
  • Fax: 951-684-1551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number11928
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: