Provider Demographics
NPI:1760502272
Name:GOLDENSON, RICHARD J (DC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:GOLDENSON
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 1:2814 SEPULVEDA BLVD
Mailing Address - Street 2:SUITE H
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-2863
Mailing Address - Country:US
Mailing Address - Phone:310-539-7380
Mailing Address - Fax:310-593-1456
Practice Address - Street 1:2814 SEPULVEDA BLVD
Practice Address - Street 2:SUITE H
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-2863
Practice Address - Country:US
Practice Address - Phone:310-539-7380
Practice Address - Fax:310-593-1456
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23008111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC23008Medicare ID - Type Unspecified
CAU51375Medicare UPIN