MEDICARE: DR. PHILIP ANTHONY RICCHIAZZI JR. D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DC29965	CA

General Provider Information

NPI Number	:	1063452894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILIP ANTHONY RICCHIAZZI JR. D.C.

Provider Business Mailing Address
First Line	:	1940 HILLHURST AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-2712
Country	:	US
Telephone Number	:	323-345-6030
Fax Number	:

Provider Business Practice Location Address
First Line	:	1940 HILLHURST AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-2712
Country	:	US
Telephone Number	:	323-345-6030
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	05/16/2011

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