=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134434566
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RICHTER CHIROPRACTIC INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/10/2010
-----------------------------------------------------
Last Update Date | 08/10/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 236 JAMACHA RD STE 101
-----------------------------------------------------
City | EL CAJON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92019-2366
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-670-7500
-----------------------------------------------------
Fax | 619-593-7171
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 236 JAMACHA RD STE 101
-----------------------------------------------------
City | EL CAJON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92019-2366
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-670-7500
-----------------------------------------------------
Fax | 619-593-7171
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MACE RICHTER
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 619-670-7500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | DC16498
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------