MEDICARE: DR. CHARLES EDWARD RICHARDSON III 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	DC33073	CA

General Provider Information

NPI Number	:	1215331475
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES EDWARD RICHARDSON III D.C.

Provider Business Mailing Address
First Line	:	6738 HINDS AVE
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606-1611
Country	:	US
Telephone Number	:	818-967-9874
Fax Number	:	818-352-8116

Provider Business Practice Location Address
First Line	:	7709 FOOTHILL BLVD
Second Line	:
City	:	TUJUNGA
State	:	CA
Zip	:	91042-2120
Country	:	US
Telephone Number	:	818-804-0525
Fax Number	:	818-352-8116

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

Provider Enumeration Date	:	10/17/2014
Last Update Date	:	10/20/2014

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