Provider Demographics
NPI:1235153172
Name:NASSAB, RICHARD GEORGE (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:GEORGE
Last Name:NASSAB
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:21001 SAN RAMON VALLEY BOULEVARD
Mailing Address - Street 2:#A4 #139
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583
Mailing Address - Country:US
Mailing Address - Phone:925-999-8757
Mailing Address - Fax:925-460-8437
Practice Address - Street 1:5820 FOOTHILL BOULEVARD
Practice Address - Street 2:SUITE 115
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588
Practice Address - Country:US
Practice Address - Phone:925-999-8757
Practice Address - Fax:925-460-8437
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2011-03-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA14703111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT05473Medicare UPIN