Provider Demographics
NPI:1023232733
Name:GERARDO, RICHARD C (DC)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:C
Last Name:GERARDO
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 1:2950 W BURBANK BLVD
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-2309
Mailing Address - Country:US
Mailing Address - Phone:818-954-8804
Mailing Address - Fax:818-848-7701
Practice Address - Street 1:2950 W BURBANK BLVD
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-2309
Practice Address - Country:US
Practice Address - Phone:818-954-8804
Practice Address - Fax:818-848-7701
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC17147111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0171470OtherBLUE SHIELD
CADC 17147OtherCALIFORNIA LICENSE NUMBER
CADC 17147OtherCALIFORNIA LICENSE NUMBER