Provider Demographics
NPI:1760534929
Name:FORD, RICHARD L (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:L
Last Name:FORD
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 1:7758 HAYWOOD PL
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-0365
Mailing Address - Country:US
Mailing Address - Phone:385-216-6571
Mailing Address - Fax:801-546-6915
Practice Address - Street 1:7758 HAYWOOD PL
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-0365
Practice Address - Country:US
Practice Address - Phone:385-216-6571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34884111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor