Provider Demographics
NPI:1578641510
Name:SOMMERS, RICHARD PHILLIP (DC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:PHILLIP
Last Name:SOMMERS
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 1:820 CRATER LAKE AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504
Mailing Address - Country:US
Mailing Address - Phone:541-776-0022
Mailing Address - Fax:541-776-0022
Practice Address - Street 1:820 CRATER LAKE AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504
Practice Address - Country:US
Practice Address - Phone:541-776-0022
Practice Address - Fax:541-776-0022
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3260111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR182783Medicaid
OR182783Medicaid