Provider Demographics
NPI:1184659013
Name:DOEDE, RICHARD C (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:C
Last Name:DOEDE
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 1:8919 E BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99212-2719
Mailing Address - Country:US
Mailing Address - Phone:509-924-7374
Mailing Address - Fax:509-927-8896
Practice Address - Street 1:8919 E BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99212-2719
Practice Address - Country:US
Practice Address - Phone:509-924-7374
Practice Address - Fax:509-927-8896
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001351111N00000X
OR1557111N00000X
IDC-510111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA91-1046552OtherTIN
WAT02284Medicare UPIN
WA91-1046552OtherTIN