Provider Demographics
NPI:1356483648
Name:KETRING, RICHARD ALLEN (DC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:ALLEN
Last Name:KETRING
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 1:1175 HARVARD WAY
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-2106
Mailing Address - Country:US
Mailing Address - Phone:775-329-4402
Mailing Address - Fax:775-329-8545
Practice Address - Street 1:1175 HARVARD WAY
Practice Address - Street 2:POWER HEALTH CHIROPRACTIC
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-2106
Practice Address - Country:US
Practice Address - Phone:775-329-4402
Practice Address - Fax:775-329-8545
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB00684111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV38338Medicare ID - Type Unspecified
U66912Medicare UPIN