Healthcare Provider Details

I. General information

NPI: 1457539371
Provider Name (Legal Business Name): RICHARD CHARLES ALLEGRO D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2008
Last Update Date: 02/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12215 VENTURA BLVD SUITE 208
STUDIO CITY CA
91604-2533
US

IV. Provider business mailing address

12215 VENTURA BLVD SUITE 208
STUDIO CITY CA
91604-2533
US

V. Phone/Fax

Practice location:
  • Phone: 818-505-0816
  • Fax: 818-505-8623
Mailing address:
  • Phone: 818-505-0816
  • Fax: 818-505-8623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number17351
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: