MEDICARE: DR. JUSTIN RICHARDSON 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	40798	CA

General Provider Information

NPI Number	:	1386841443
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUSTIN RICHARDSON D.C.

Provider Business Mailing Address
First Line	:	PO BOX 280567
Second Line	:
City	:	NORTHRIDGE
State	:	CA
Zip	:	91328-0567
Country	:	US
Telephone Number	:	818-703-1883
Fax Number	:

Provider Business Practice Location Address
First Line	:	22110 ROSCOE BLVD
Second Line	:	SUITE 304
City	:	WEST HILLS
State	:	CA
Zip	:	91304-3845
Country	:	US
Telephone Number	:	818-703-1883
Fax Number	:	818-703-9911

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

Provider Enumeration Date	:	06/29/2007
Last Update Date	:	07/08/2007

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