Provider Demographics
NPI:1497888598
Name:RICHARD V. AUSTIN,D.C.,A PROFESSIONAL CHIROPRACTIC CORPORATION
Entity type:Organization
Organization Name:RICHARD V. AUSTIN,D.C.,A PROFESSIONAL CHIROPRACTIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:VANCE
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:760-789-3864
Mailing Address - Street 1:414 11TH ST
Mailing Address - Street 2:P.O. BOX 507
Mailing Address - City:RAMONA
Mailing Address - State:CA
Mailing Address - Zip Code:92065-3912
Mailing Address - Country:US
Mailing Address - Phone:760-789-3864
Mailing Address - Fax:760-789-3888
Practice Address - Street 1:414 11TH ST
Practice Address - Street 2:
Practice Address - City:RAMONA
Practice Address - State:CA
Practice Address - Zip Code:92065-3912
Practice Address - Country:US
Practice Address - Phone:760-789-3864
Practice Address - Fax:760-789-3888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC11399111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT17082Medicare UPIN
CADC11399Medicare ID - Type Unspecified