=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134211360
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEALTHWORKS CHIROPRACTIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/28/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 960 E GREEN ST SUITE L-3
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91106-2401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-698-0655
-----------------------------------------------------
Fax | 626-737-0285
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 960 E GREEN ST SUITE L-3
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91106-2401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-698-0655
-----------------------------------------------------
Fax | 626-737-0285
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. PHILIP ANTHONY RICCHIAZZI JR.
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 626-698-0655
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC29965
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------