Provider Demographics
NPI:1669487187
Name:HIJAZI, RICHARD LAWRENCE (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LAWRENCE
Last Name:HIJAZI
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 1:8762 W GREENBRIAN DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-3045
Mailing Address - Country:US
Mailing Address - Phone:623-322-2633
Mailing Address - Fax:
Practice Address - Street 1:15182 N 75TH AVE
Practice Address - Street 2:SUITE 160
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4722
Practice Address - Country:US
Practice Address - Phone:623-334-5010
Practice Address - Fax:623-334-0742
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7535111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor