Provider Demographics
NPI:1508624024
Name:RIKKE CHIROPRACTIC PC
Entity Type:Organization
Organization Name:RIKKE CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RIKKE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC, CCSP, EMT, CPT
Authorized Official - Phone:650-853-1800
Mailing Address - Street 1:609 COWPER ST
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94301-1808
Mailing Address - Country:US
Mailing Address - Phone:650-484-0110
Mailing Address - Fax:650-640-0110
Practice Address - Street 1:609 COWPER ST
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-1808
Practice Address - Country:US
Practice Address - Phone:650-484-0110
Practice Address - Fax:650-640-0110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-08
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty