Provider Demographics
NPI:1245230929
Name:CAPACIO, RICHARD S (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:S
Last Name:CAPACIO
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 1:410 TIMBER CIRCLE
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087-2358
Mailing Address - Country:US
Mailing Address - Phone:215-468-6800
Mailing Address - Fax:215-468-6801
Practice Address - Street 1:1837 S 2ND STREET
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19148
Practice Address - Country:US
Practice Address - Phone:215-468-6800
Practice Address - Fax:215-468-6801
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002723L111N00000X, 111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA271474OtherBLUE CROSS BLUE SHIELD
PA01131437Medicaid
PAU18197Medicare UPIN
PA01131437Medicaid