Provider Demographics
NPI:1043386998
Name:HEARN, RAYMOND LONNIE (DC)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:LONNIE
Last Name:HEARN
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 1:1756 MILEGROUND PLAZA
Mailing Address - Street 2:SUITE I
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-3785
Mailing Address - Country:US
Mailing Address - Phone:304-292-2900
Mailing Address - Fax:304-292-2900
Practice Address - Street 1:1756 MILEGROUND PLAZA
Practice Address - Street 2:SUITE I
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-3785
Practice Address - Country:US
Practice Address - Phone:304-292-2900
Practice Address - Fax:304-292-2900
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV365111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV365OtherSTATE LICENSE
T32369Medicare UPIN
WVHE0549001Medicare ID - Type Unspecified