Provider Demographics
NPI:1760482756
Name:MCINTYRE, RICHARD MATTHEW (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:MATTHEW
Last Name:MCINTYRE
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 1:3046 HARTSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-8514
Mailing Address - Country:US
Mailing Address - Phone:702-914-6950
Mailing Address - Fax:702-914-6950
Practice Address - Street 1:9555 S EASTERN AVE
Practice Address - Street 2:SUITE 240
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-8008
Practice Address - Country:US
Practice Address - Phone:702-301-3862
Practice Address - Fax:702-914-6950
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB 149111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV668342OtherANTHEM BCBS HMO, PPO
NV668342OtherANTHEM BCBS HMO, PPO
NVV38706Medicare ID - Type Unspecified