Provider Demographics
NPI:1467632760
Name:RICHETTO, PAUL ANDREW (DC)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ANDREW
Last Name:RICHETTO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:P.
Other - Middle Name:ANDREW
Other - Last Name:RICHETTO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:5445 DTC PKWY STE 1130
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-3038
Mailing Address - Country:US
Mailing Address - Phone:720-749-5599
Mailing Address - Fax:720-925-5897
Practice Address - Street 1:2222 W DUNLAP AVE STE 190
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-2800
Practice Address - Country:US
Practice Address - Phone:602-584-9661
Practice Address - Fax:720-925-5897
Is Sole Proprietor?:No
Enumeration Date:2007-11-05
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7873111N00000X
AZ4562111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0400XChiropractic ProvidersChiropractorRehabilitation