Provider Demographics
NPI:1790892958
Name:GARABEDIAN, RICHARD S (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:S
Last Name:GARABEDIAN
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 1:2133 HIGH STREET
Mailing Address - Street 2:SUITE C
Mailing Address - City:SELMA
Mailing Address - State:CA
Mailing Address - Zip Code:93662
Mailing Address - Country:US
Mailing Address - Phone:559-896-3224
Mailing Address - Fax:559-896-3750
Practice Address - Street 1:2133 HIGH STREET
Practice Address - Street 2:SUITE C
Practice Address - City:SELMA
Practice Address - State:CA
Practice Address - Zip Code:93662
Practice Address - Country:US
Practice Address - Phone:559-896-3224
Practice Address - Fax:559-896-3750
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23652111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA23652OtherLICENSE
CA23652OtherLICENSE
DC0236520Medicare ID - Type Unspecified