Provider Demographics
NPI:1518159342
Name:RICKARDS, RAYMOND ROBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:ROBERT
Last Name:RICKARDS
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:PO BOX 546
Mailing Address - Street 2:
Mailing Address - City:CARDIFF
Mailing Address - State:CA
Mailing Address - Zip Code:92007-0546
Mailing Address - Country:US
Mailing Address - Phone:858-436-7600
Mailing Address - Fax:760-797-1845
Practice Address - Street 1:1340 W VALLEY PKWY STE 201
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92029-2136
Practice Address - Country:US
Practice Address - Phone:760-745-1511
Practice Address - Fax:760-735-5885
Is Sole Proprietor?:No
Enumeration Date:2007-08-15
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC12519111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWDC12519AOtherMEDICARE PTAN FOR DOCTOR
CAW21266OtherMEDICARE PTAN FOR CORP.