Provider Demographics
NPI:1336386887
Name:MATTHEW RICHTER DC CHIROPRACTIC INC
Entity Type:Organization
Organization Name:MATTHEW RICHTER DC CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:951-817-9815
Mailing Address - Street 1:7931 PORT ARTHUR DR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92880-3542
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:854 MAGNOLIA AVE
Practice Address - Street 2:STE. J
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-3109
Practice Address - Country:US
Practice Address - Phone:951-817-9815
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-20
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25172111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0251720Medicare PIN