Provider Demographics
NPI:1083695076
Name:STILL, RICK D (DC)
Entity Type:Individual
Prefix:DR
First Name:RICK
Middle Name:D
Last Name:STILL
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 1:1815 HUDSON ST
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-2913
Mailing Address - Country:US
Mailing Address - Phone:360-636-2636
Mailing Address - Fax:360-636-2621
Practice Address - Street 1:1815 HUDSON ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2913
Practice Address - Country:US
Practice Address - Phone:360-636-2636
Practice Address - Fax:360-636-2621
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001766111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2010643Medicaid
WAGO00700235Medicare ID - Type UnspecifiedMEDICRE #
WAT91043Medicare UPIN