Provider Demographics
NPI:1235782517
Name:RICCHIO, GEOFFREY KENNETH (DC)
Entity Type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:KENNETH
Last Name:RICCHIO
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 1:31805 TEMECULA PKWY # 802
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-8203
Mailing Address - Country:US
Mailing Address - Phone:951-383-6062
Mailing Address - Fax:888-778-5824
Practice Address - Street 1:31093 TEMECULA PKWY # D-5
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-3087
Practice Address - Country:US
Practice Address - Phone:951-303-9222
Practice Address - Fax:888-778-5824
Is Sole Proprietor?:No
Enumeration Date:2019-07-16
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16827111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor