Provider Demographics
NPI:1497947642
Name:RICHARD W. PROSSER, DC PA
Entity Type:Organization
Organization Name:RICHARD W. PROSSER, DC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:WISE
Authorized Official - Last Name:PROSSER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-794-6239
Mailing Address - Street 1:845 CHURCH ST N
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-4300
Mailing Address - Country:US
Mailing Address - Phone:704-794-6239
Mailing Address - Fax:704-794-6240
Practice Address - Street 1:845 CHURCH ST N
Practice Address - Street 2:SUITE 210
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-4300
Practice Address - Country:US
Practice Address - Phone:704-794-6239
Practice Address - Fax:704-794-6240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1405111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC244390CMedicare PIN