Provider Demographics
NPI:1295189405
Name:C.E. RICHARDSON CHIROPRACTIC INC
Entity Type:Organization
Organization Name:C.E. RICHARDSON CHIROPRACTIC INC
Other - Org Name:FREE MY SPINE HEALTH GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:818-455-5443
Mailing Address - Street 1:7904 FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:SUNLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91040-2937
Mailing Address - Country:US
Mailing Address - Phone:818-455-5443
Mailing Address - Fax:818-230-0443
Practice Address - Street 1:7904 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:SUNLAND
Practice Address - State:CA
Practice Address - Zip Code:91040-2937
Practice Address - Country:US
Practice Address - Phone:818-455-5443
Practice Address - Fax:818-230-0443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-14
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33073111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty