Provider Demographics
NPI:1508175753
Name:RICHETTO CHIROPRACTIC AND REHABILITATION
Entity Type:Organization
Organization Name:RICHETTO CHIROPRACTIC AND REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF TREATING PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:RICHETTO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-775-3503
Mailing Address - Street 1:37852 N BEVERLY AVE
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85140-4186
Mailing Address - Country:US
Mailing Address - Phone:480-775-3503
Mailing Address - Fax:480-775-3508
Practice Address - Street 1:37852 N BEVERLY AVE
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85140-4186
Practice Address - Country:US
Practice Address - Phone:480-775-3503
Practice Address - Fax:480-775-3508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-05
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7378111N00000X
AZ4562111NR0400X
AZ4562PT261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty