Provider Demographics
NPI:1861625485
Name:RICHICHI, JOSEPH M (DC)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:M
Last Name:RICHICHI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:JOSEPH
Other - Middle Name:M
Other - Last Name:RICHICHI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:581 GRAND AVE
Mailing Address - Street 2:UPSTAIRS
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-3101
Mailing Address - Country:US
Mailing Address - Phone:631-612-1447
Mailing Address - Fax:
Practice Address - Street 1:581 GRAND AVE
Practice Address - Street 2:UPSTAIRS
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-3101
Practice Address - Country:US
Practice Address - Phone:631-612-1447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-30
Last Update Date:2009-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX005981-1111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation