Provider Demographics
NPI:1558374207
Name:AUSTIN, RICHARD L (DC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:L
Last Name:AUSTIN
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 1:215 SE URANIA LN
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1623
Mailing Address - Country:US
Mailing Address - Phone:541-668-1211
Mailing Address - Fax:541-833-5007
Practice Address - Street 1:215 SE URANIA LN
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1623
Practice Address - Country:US
Practice Address - Phone:541-668-1211
Practice Address - Fax:541-833-5007
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC16250111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T18284Medicare UPIN
CADC16250Medicare ID - Type Unspecified