Provider Demographics
NPI:1497709679
Name:DAMSCHRODER, RICHARD LEE JR (DC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:LEE
Last Name:DAMSCHRODER
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 1:3075 W ELM ST
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-2514
Mailing Address - Country:US
Mailing Address - Phone:419-224-5678
Mailing Address - Fax:419-221-3340
Practice Address - Street 1:3075 W ELM ST
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-2514
Practice Address - Country:US
Practice Address - Phone:419-224-5678
Practice Address - Fax:419-221-3340
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
OH3488111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0387157Medicaid
OH99103Medicare UPIN
OH0387157Medicaid