Provider Demographics
NPI:1073634010
Name:SCALCO, RICHARD J JR (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:J
Last Name:SCALCO
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34700 PACIFIC COAST HWY
Mailing Address - Street 2:SUITE 309
Mailing Address - City:CAPISTRANO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92624-1351
Mailing Address - Country:US
Mailing Address - Phone:949-887-9796
Mailing Address - Fax:
Practice Address - Street 1:34700 PACIFIC COAST HWY
Practice Address - Street 2:SUITE 309
Practice Address - City:CAPISTRANO BEACH
Practice Address - State:CA
Practice Address - Zip Code:92624-1351
Practice Address - Country:US
Practice Address - Phone:949-887-9796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC21115111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor