Provider Demographics
NPI:1083744569
Name:MONSOUR, RICHARD (DC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:MONSOUR
Suffix:
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 1:7598 MONTEREY ST
Mailing Address - Street 2:STE 130
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-5869
Mailing Address - Country:US
Mailing Address - Phone:408-848-6454
Mailing Address - Fax:
Practice Address - Street 1:8343 CHURCH ST # D
Practice Address - Street 2:
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-4406
Practice Address - Country:US
Practice Address - Phone:408-848-6454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16643111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor