Provider Demographics
NPI:1538264718
Name:DINA, RICHARD C (DC)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:C
Last Name:DINA
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:P.O. BOX 2928
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405
Mailing Address - Country:US
Mailing Address - Phone:707-595-4112
Mailing Address - Fax:844-595-2112
Practice Address - Street 1:707 HAHMAN DRIVE
Practice Address - Street 2:#2928
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405
Practice Address - Country:US
Practice Address - Phone:707-595-4112
Practice Address - Fax:844-595-2112
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25428111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor