Provider Demographics
NPI:1942206248
Name:TREVISIN, RICHARD F (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:F
Last Name:TREVISIN
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 1:12409 RANCHO BERNARDO RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-2143
Mailing Address - Country:US
Mailing Address - Phone:858-485-8220
Mailing Address - Fax:858-485-8222
Practice Address - Street 1:12409 RANCHO BERNARDO RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2143
Practice Address - Country:US
Practice Address - Phone:858-485-8220
Practice Address - Fax:858-485-8222
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC12563111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC12563OtherLICENSE
CADC12563OtherLICENSE
CAT17390Medicare UPIN