Provider Demographics
NPI:1598802290
Name:ORNELAS, RICHARD P II (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:P
Last Name:ORNELAS
Suffix:II
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 1:1112 S 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85701-3111
Mailing Address - Country:US
Mailing Address - Phone:520-622-6765
Mailing Address - Fax:520-791-0237
Practice Address - Street 1:1112 S 5TH AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85701-3111
Practice Address - Country:US
Practice Address - Phone:520-622-6765
Practice Address - Fax:520-791-0237
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5671111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZU72878Medicare UPIN
AZ24917Medicare ID - Type Unspecified