Provider Demographics
NPI:1710069398
Name:DARK, RICHARD A (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
Last Name:DARK
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 1:1 MOUNT MCKINLEY AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11738-2107
Mailing Address - Country:US
Mailing Address - Phone:631-736-0900
Mailing Address - Fax:631-736-3842
Practice Address - Street 1:1 MOUNT MCKINLEY AVE
Practice Address - Street 2:
Practice Address - City:FARMINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:11738-2107
Practice Address - Country:US
Practice Address - Phone:631-736-0900
Practice Address - Fax:631-736-3842
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX004836-1111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA11-2946756OtherLANDMARK
CA320250OtherAMERICAN SPECIALTY HEALTH
NY76833OtherAETNA
CT8983718-00OtherCIGNA
NY0017091OtherGHI
NY115137OtherMPN
NY1280677OtherUNITED HEALTH CARE
NYP647932OtherOXFORD
NY115137OtherMPN
NYP647932OtherOXFORD