MEDICARE: DR. RICHARD TRUJILLO DC

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	DC32682	CA

General Provider Information

NPI Number	:	1437589637
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD TRUJILLO DC

Provider Business Mailing Address
First Line	:	15985 WINNEBAGO RD
Second Line	:
City	:	APPLE VALLEY
State	:	CA
Zip	:	92307-3049
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12139 MOUNT VERNON AVE STE 100
Second Line	:
City	:	GRAND TERRACE
State	:	CA
Zip	:	92313-5519
Country	:	US
Telephone Number	:	909-783-4950
Fax Number	:

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

Provider Enumeration Date	:	11/25/2013
Last Update Date	:	11/25/2013

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