Provider Demographics
NPI:1841335627
Name:LINDWALL, RICHARD CURTIS JR (DC)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:CURTIS
Last Name:LINDWALL
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:11683 CHERRY AVE STE 9
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92337-2787
Mailing Address - Country:US
Mailing Address - Phone:909-428-0700
Mailing Address - Fax:909-743-5856
Practice Address - Street 1:11683 CHERRY AVE STE 9
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92337-2787
Practice Address - Country:US
Practice Address - Phone:909-428-0700
Practice Address - Fax:909-743-5856
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18511111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0185110Medicare ID - Type Unspecified