Provider Demographics
NPI:1689878159
Name:RICHARD J PROUGH JR. PC
Entity Type:Organization
Organization Name:RICHARD J PROUGH JR. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:PROUGH
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:724-731-0210
Mailing Address - Street 1:3402 WASHINGTON RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MCMURRAY
Mailing Address - State:PA
Mailing Address - Zip Code:15317-2964
Mailing Address - Country:US
Mailing Address - Phone:724-731-0210
Mailing Address - Fax:724-731-0216
Practice Address - Street 1:3402 WASHINGTON RD
Practice Address - Street 2:SUITE 201
Practice Address - City:MCMURRAY
Practice Address - State:PA
Practice Address - Zip Code:15317-2964
Practice Address - Country:US
Practice Address - Phone:724-731-0210
Practice Address - Fax:724-731-0216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004554-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0171360Medicaid
PAU16803Medicare UPIN
PA0171360Medicaid