Provider Demographics
NPI:1659596419
Name:RICKARD CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:RICKARD CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:RICKARD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:808-887-1918
Mailing Address - Street 1:1862 GREEN MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:MEADOW VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:95722-9403
Mailing Address - Country:US
Mailing Address - Phone:530-392-3009
Mailing Address - Fax:
Practice Address - Street 1:1862 GREEN MEADOW LN
Practice Address - Street 2:
Practice Address - City:MEADOW VISTA
Practice Address - State:CA
Practice Address - Zip Code:95722-9403
Practice Address - Country:US
Practice Address - Phone:530-392-3009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDC913111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI55859Medicare ID - Type UnspecifiedMEDICARE #