Provider Demographics
NPI:1861415309
Name:LIND, RICHARD ERNEST (DC)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ERNEST
Last Name:LIND
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 1:712 E LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92865-1808
Mailing Address - Country:US
Mailing Address - Phone:714-998-8650
Mailing Address - Fax:714-998-8281
Practice Address - Street 1:712 E LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92865-1808
Practice Address - Country:US
Practice Address - Phone:714-998-8650
Practice Address - Fax:714-998-8281
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13594111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT05071Medicare UPIN
CADC13594Medicare ID - Type Unspecified