Provider Demographics
NPI:1467662767
Name:BONE, RICHARD (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:BONE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:RICHARD
Other - Middle Name:
Other - Last Name:BONE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 2591
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73402-2591
Mailing Address - Country:US
Mailing Address - Phone:580-226-8877
Mailing Address - Fax:
Practice Address - Street 1:1409 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-2839
Practice Address - Country:US
Practice Address - Phone:580-226-8877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2425111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor