Provider Demographics
NPI:1003034190
Name:PLAYER, RICHARD LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LEE
Last Name:PLAYER
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 1:1705 MCPHERSON AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-5175
Mailing Address - Country:US
Mailing Address - Phone:712-322-6336
Mailing Address - Fax:
Practice Address - Street 1:1705 MCPHERSON AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-5175
Practice Address - Country:US
Practice Address - Phone:712-322-6336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06666111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0424721Medicaid
IAU98935Medicare UPIN
IAI11765Medicare ID - Type Unspecified