Provider Demographics
NPI:1457462145
Name:COHEN, RICHARD (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:COHEN
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 1:417 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-5418
Mailing Address - Country:US
Mailing Address - Phone:570-283-1011
Mailing Address - Fax:570-283-1465
Practice Address - Street 1:417 MARKET ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-5418
Practice Address - Country:US
Practice Address - Phone:570-283-1011
Practice Address - Fax:570-283-1465
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003001L111NR0400X, 111NS0005X, 111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA141077OtherBLUE CROSS BLUE SHIELD
PA0011084750002Medicaid
PA141077OtherBLUE CROSS BLUE SHIELD
PA141077JYHMedicare ID - Type Unspecified