Provider Demographics
NPI:1760557318
Name:RICHTER, MACE CHARLES (DC)
Entity Type:Individual
Prefix:
First Name:MACE
Middle Name:CHARLES
Last Name:RICHTER
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 1:236 JAMACHA RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92019-2366
Mailing Address - Country:US
Mailing Address - Phone:619-670-7500
Mailing Address - Fax:619-593-7171
Practice Address - Street 1:236 JAMACHA RD
Practice Address - Street 2:SUITE 101
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92019-2366
Practice Address - Country:US
Practice Address - Phone:619-670-7500
Practice Address - Fax:619-593-7171
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC16498111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT18349Medicare UPIN