Provider Demographics
NPI:1639352701
Name:MATERA, RICHARD GENE I (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:GENE
Last Name:MATERA
Suffix:I
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 1:1220 UNIVERSITY DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-4262
Mailing Address - Country:US
Mailing Address - Phone:650-838-1170
Mailing Address - Fax:650-323-1174
Practice Address - Street 1:1220 UNIVERSITY DR
Practice Address - Street 2:SUITE 202
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-4262
Practice Address - Country:US
Practice Address - Phone:650-838-1170
Practice Address - Fax:650-323-1174
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-12
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26975DC111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor