Provider Demographics
NPI:1205187622
Name:KOERBER, RICHARD EVAN (MAC)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:EVAN
Last Name:KOERBER
Suffix:
Gender:M
Credentials:MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:667 BREVARD RD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-2237
Mailing Address - Country:US
Mailing Address - Phone:828-666-7406
Mailing Address - Fax:828-667-0042
Practice Address - Street 1:667 BREVARD RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-2237
Practice Address - Country:US
Practice Address - Phone:828-666-7406
Practice Address - Fax:828-667-0042
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-25
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0021171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist