Provider Demographics
NPI:1093825416
Name:MORELLI, RICARDO AGUSTIN (DC)
Entity Type:Individual
Prefix:
First Name:RICARDO
Middle Name:AGUSTIN
Last Name:MORELLI
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 1:1030 S GLENDALE AVE
Mailing Address - Street 2:SUITE 307
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-5612
Mailing Address - Country:US
Mailing Address - Phone:818-507-5253
Mailing Address - Fax:818-507-5203
Practice Address - Street 1:1030 S GLENDALE AVE
Practice Address - Street 2:SUITE 307
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-5612
Practice Address - Country:US
Practice Address - Phone:818-507-5253
Practice Address - Fax:818-507-5203
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23067111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2273528OtherFIRST HEALTH PROVIDER ID
CA642565OtherACN PROVIDER NETWORK
CA5571838OtherCCN PROVIDER ID
CA5571838OtherCCN PROVIDER ID
CA642565OtherACN PROVIDER NETWORK