Provider Demographics
NPI:1508099763
Name:POTTERS, RISA (DC)
Entity Type:Individual
Prefix:DR
First Name:RISA
Middle Name:
Last Name:POTTERS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30473 MULHOLLAND HWY SPC 213
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-6226
Mailing Address - Country:US
Mailing Address - Phone:818-264-8128
Mailing Address - Fax:
Practice Address - Street 1:30473 MULHOLLAND HWY SPC 213
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-6226
Practice Address - Country:US
Practice Address - Phone:818-264-8128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-03
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23570111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor