Provider Demographics
NPI:1205339546
Name:ITO, RIE (DC)
Entity type:Individual
Prefix:DR
First Name:RIE
Middle Name:
Last Name:ITO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27741 CROWN VALLEY PKWY
Mailing Address - Street 2:SUITE 211
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691
Mailing Address - Country:US
Mailing Address - Phone:949-345-5972
Mailing Address - Fax:800-547-6550
Practice Address - Street 1:27741 CROWN VALLEY PKWY
Practice Address - Street 2:SUITE 211
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691
Practice Address - Country:US
Practice Address - Phone:949-345-5972
Practice Address - Fax:800-547-6550
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-13
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34066111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor