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General NPI Number Information
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NPI Number | 1609086560
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Entity Type | Individual
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Provider Name | RICHARD GREGORY FOURZON D.C.
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Gender | Male
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 01/11/2011
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Provider Practice Location Address
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Address Line | 585 WEST COLLEGE AVENUE SUITE: B
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City | SANTA ROSA
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State | CA
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Zip | 95401-5060
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Country | US
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Telephone | 707-579-2234
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Fax | 707-579-6001
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Provider Business Mailing Address
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Address Line | 585 WEST COLLEGE AVENUE SUITE: B
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City | SANTA ROSA
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State | CA
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Zip | 95401-5060
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Country | US
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Telephone | 707-579-2234
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Fax | 707-579-6001
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 18409
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC0184090
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License Number State | CA
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