Provider Demographics
NPI:1154328680
Name:CHEN, RICKY (DC)
Entity Type:Individual
Prefix:DR
First Name:RICKY
Middle Name:
Last Name:CHEN
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:P.O. BOX 752
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:CA
Mailing Address - Zip Code:90702-0752
Mailing Address - Country:US
Mailing Address - Phone:562-924-8882
Mailing Address - Fax:562-924-7511
Practice Address - Street 1:17726 PIONEER BLVD STE B
Practice Address - Street 2:
Practice Address - City:ARTESIA
Practice Address - State:CA
Practice Address - Zip Code:90701-4061
Practice Address - Country:US
Practice Address - Phone:562-924-8882
Practice Address - Fax:562-924-7511
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC21268111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0212680Medicaid
CADC21268Medicare ID - Type Unspecified
CADC0212680Medicaid