Provider Demographics
NPI:1639152648
Name:PROUGH, RICHARD J JR (DC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:PROUGH
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 1:1511 ROSEWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:N HUNTINGDON
Mailing Address - State:PA
Mailing Address - Zip Code:15642-2293
Mailing Address - Country:US
Mailing Address - Phone:412-678-9123
Mailing Address - Fax:412-678-9127
Practice Address - Street 1:3045 JACKS RUN RD
Practice Address - Street 2:
Practice Address - City:WHITE OAK
Practice Address - State:PA
Practice Address - Zip Code:15131-2523
Practice Address - Country:US
Practice Address - Phone:412-678-9123
Practice Address - Fax:412-678-9127
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC045540111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01713600Medicaid
646482Medicare ID - Type Unspecified
PA01713600Medicaid