Provider Demographics
NPI:1083834493
Name:HARGREAVES, RICHARD OWEN (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:OWEN
Last Name:HARGREAVES
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 1:4817 LIGHTHOUSE DR
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:WA
Mailing Address - Zip Code:98230-9628
Mailing Address - Country:US
Mailing Address - Phone:360-371-5453
Mailing Address - Fax:
Practice Address - Street 1:1332 164TH ST SW
Practice Address - Street 2:SUITE 401
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98087-8513
Practice Address - Country:US
Practice Address - Phone:425-742-7772
Practice Address - Fax:425-742-9001
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001968111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor