MEDICARE: RICHETTO CHIROPRACTIC AND REHABILITATION

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	111NR0400X	Rehabilitation Chiropractor	4562	AZ
2	261QP2000X	Physical Therapy Clinic/Center	4562PT	AZ
3	111N00000X	Chiropractor	7378	AZ

General Provider Information

NPI Number	:	1508175753
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICHETTO CHIROPRACTIC AND REHABILITATION

Provider Business Mailing Address
First Line	:	37852 N BEVERLY AVE
Second Line	:
City	:	QUEEN CREEK
State	:	AZ
Zip	:	85140-4186
Country	:	US
Telephone Number	:	480-775-3503
Fax Number	:	480-775-3508

Provider Business Practice Location Address
First Line	:	37852 N BEVERLY AVE
Second Line	:
City	:	QUEEN CREEK
State	:	AZ
Zip	:	85140-4186
Country	:	US
Telephone Number	:	480-775-3503
Fax Number	:	480-775-3508

Authorized Official
Title or Position	:	CHIEF TREATING PHYSICIAN
Name	:	DR. PAUL ANDREW RICHETTO
Credential	:	D.C.
Telephone Number	:	480-775-3503

Provider Enumeration Date	:	10/05/2010
Last Update Date	:	01/24/2011

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Directions to “RICHETTO CHIROPRACTIC AND REHABILITATION ” Practice Location

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