Provider Demographics
NPI:1467417311
Name:RAFFERTY, RICHARD M (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:M
Last Name:RAFFERTY
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 1:2049 BRODHEAD RD
Mailing Address - Street 2:
Mailing Address - City:ALIQUIPPA
Mailing Address - State:PA
Mailing Address - Zip Code:15001-4977
Mailing Address - Country:US
Mailing Address - Phone:724-378-4001
Mailing Address - Fax:724-378-4510
Practice Address - Street 1:2049 BRODHEAD RD
Practice Address - Street 2:
Practice Address - City:ALIQUIPPA
Practice Address - State:PA
Practice Address - Zip Code:15001-4977
Practice Address - Country:US
Practice Address - Phone:724-378-4001
Practice Address - Fax:724-378-4510
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003971-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA674692Medicare ID - Type Unspecified