Provider Demographics
NPI:1467535369
Name:JUSTICE, RICK L (BA, DC)
Entity Type:Individual
Prefix:
First Name:RICK
Middle Name:L
Last Name:JUSTICE
Suffix:
Gender:M
Credentials:BA, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3007 DALE CT
Mailing Address - Street 2:
Mailing Address - City:CERES
Mailing Address - State:CA
Mailing Address - Zip Code:95307-2913
Mailing Address - Country:US
Mailing Address - Phone:209-537-4579
Mailing Address - Fax:209-537-1550
Practice Address - Street 1:3007 DALE CT
Practice Address - Street 2:
Practice Address - City:CERES
Practice Address - State:CA
Practice Address - Zip Code:95307-2913
Practice Address - Country:US
Practice Address - Phone:209-537-4579
Practice Address - Fax:209-537-1550
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC18471111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0184710Medicare ID - Type UnspecifiedMEDICARE
CAU30784Medicare UPIN