Provider Demographics
NPI:1518046028
Name:CIMADORO, RICHARD ROLAND (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ROLAND
Last Name:CIMADORO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 E HILLCREST DR STE 170
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-8251
Mailing Address - Country:US
Mailing Address - Phone:805-557-1288
Mailing Address - Fax:805-557-1277
Practice Address - Street 1:325 E HILLCREST DR STE 170
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-8251
Practice Address - Country:US
Practice Address - Phone:805-557-1288
Practice Address - Fax:805-557-1277
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26855111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6481930001Medicare NSC
CADC26855Medicare PIN