Provider Demographics
NPI:1043391634
Name:MASON, RICHARD G (DC)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:G
Last Name:MASON
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 1:11580 OVERLOOK DR
Mailing Address - Street 2:200
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-4212
Mailing Address - Country:US
Mailing Address - Phone:317-577-9558
Mailing Address - Fax:317-577-9559
Practice Address - Street 1:11580 OVERLOOK DR
Practice Address - Street 2:200
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-4212
Practice Address - Country:US
Practice Address - Phone:317-577-9558
Practice Address - Fax:317-577-9559
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002072A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000298183OtherANTHEM BC BS IN
IN000000298183OtherANTHEM BC BS IN
IN000000298183OtherANTHEM BC BS IN
INU87041Medicare UPIN
IN216930AMedicare PIN