Provider Demographics
NPI:1407871692
Name:RAYMOND, RICHARD M (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:M
Last Name:RAYMOND
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 1:1702 S 72ND ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98408-1238
Mailing Address - Country:US
Mailing Address - Phone:253-474-0677
Mailing Address - Fax:253-474-3540
Practice Address - Street 1:1702 S 72ND ST
Practice Address - Street 2:SUITE A
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98408-1238
Practice Address - Country:US
Practice Address - Phone:253-474-0677
Practice Address - Fax:253-474-3540
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002175111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WARA3981OtherRENGENCE
WA32023OtherSTATE LABOR & INDUSTRIES
WA8374597Medicaid
WA8374597Medicaid
WARA3981OtherRENGENCE