Provider Demographics
NPI:1619050689
Name:EVERETT, RICHARD C (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:C
Last Name:EVERETT
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 1:222 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:IL
Mailing Address - Zip Code:61356-1727
Mailing Address - Country:US
Mailing Address - Phone:815-875-3861
Mailing Address - Fax:815-875-1243
Practice Address - Street 1:222 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:IL
Practice Address - Zip Code:61356-1727
Practice Address - Country:US
Practice Address - Phone:815-875-3861
Practice Address - Fax:815-875-1243
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038004244111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0615603OtherBC/BS PROVIDER NUMBER
IL0615603OtherBC/BS PROVIDER NUMBER
IL726120Medicare ID - Type Unspecified