Provider Demographics
NPI:1982610820
Name:SOTTILE, RICHARD L (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:L
Last Name:SOTTILE
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:PO BOX 906
Mailing Address - Street 2:
Mailing Address - City:TEHACHAPI
Mailing Address - State:CA
Mailing Address - Zip Code:93581-0906
Mailing Address - Country:US
Mailing Address - Phone:661-822-4386
Mailing Address - Fax:661-823-1328
Practice Address - Street 1:777 W TEHACHAPI BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:TEHACHAPI
Practice Address - State:CA
Practice Address - Zip Code:93561-1635
Practice Address - Country:US
Practice Address - Phone:661-822-4386
Practice Address - Fax:661-823-1328
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC0104320111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0104320OtherBLUE SHIELD