Provider Demographics
NPI:1417901836
Name:PICARD, RICHARD E JR (DC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:E
Last Name:PICARD
Suffix:JR
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 1:342 ATWOOD AVE
Mailing Address - Street 2:UPPER LEVEL
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-4048
Mailing Address - Country:US
Mailing Address - Phone:401-942-6967
Mailing Address - Fax:
Practice Address - Street 1:342 ATWOOD AVE
Practice Address - Street 2:UPPER LEVEL
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-4048
Practice Address - Country:US
Practice Address - Phone:401-942-6967
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDCP00312111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIUI9632Medicare UPIN