Provider Demographics
NPI:1275747164
Name:NEWMAN, RICHARD MACK (DC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:MACK
Last Name:NEWMAN
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 1:39575 10 MILE ROAD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-2949
Mailing Address - Country:US
Mailing Address - Phone:248-477-1240
Mailing Address - Fax:248-477-1241
Practice Address - Street 1:39575 W 10 MILE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-2949
Practice Address - Country:US
Practice Address - Phone:248-477-1240
Practice Address - Fax:248-477-1241
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRN003080111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor