Provider Demographics
NPI:1083042568
Name:RICHARD A OWEN DC, LLC
Entity Type:Organization
Organization Name:RICHARD A OWEN DC, LLC
Other - Org Name:QUALITY CHIROPRACTIC & INJURY REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:OWEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:702-778-7186
Mailing Address - Street 1:500 E WINDMILL LN
Mailing Address - Street 2:SUITE 115
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-1843
Mailing Address - Country:US
Mailing Address - Phone:702-778-7186
Mailing Address - Fax:702-778-7423
Practice Address - Street 1:500 E WINDMILL LN
Practice Address - Street 2:SUITE 115
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-1843
Practice Address - Country:US
Practice Address - Phone:702-778-7186
Practice Address - Fax:702-778-7423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-21
Last Update Date:2013-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB00475111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
T90181Medicare UPIN