Provider Demographics
NPI:1558372003
Name:BADURA, RICHARD E (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:E
Last Name:BADURA
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 1:230 S GIRARD ST
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92544-4661
Mailing Address - Country:US
Mailing Address - Phone:951-658-2225
Mailing Address - Fax:951-658-0179
Practice Address - Street 1:230 S GIRARD ST
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92544-4661
Practice Address - Country:US
Practice Address - Phone:951-658-2225
Practice Address - Fax:951-658-0179
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0179420111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor