Provider Demographics
NPI:1972714434
Name:LOPEZ, RICHARD E (DC)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:E
Last Name:LOPEZ
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 1:14437 S DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-7924
Mailing Address - Country:US
Mailing Address - Phone:305-256-6020
Mailing Address - Fax:305-256-6002
Practice Address - Street 1:14437 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-7924
Practice Address - Country:US
Practice Address - Phone:305-256-6020
Practice Address - Fax:305-256-6002
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007620111N00000X
FLCH10860111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA697211OtherACN