Provider Demographics
NPI:1790989101
Name:OWEN, RICHARD A (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
Last Name:OWEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:RICK
Other - Middle Name:A
Other - Last Name:OWEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:500 E WINDMILL LN
Mailing Address - Street 2:SUITE 115
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-1843
Mailing Address - Country:US
Mailing Address - Phone:702-778-7186
Mailing Address - Fax:702-778-7423
Practice Address - Street 1:500 E WINDMILL LN
Practice Address - Street 2:SUITE 115
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-1843
Practice Address - Country:US
Practice Address - Phone:702-778-7186
Practice Address - Fax:702-778-7423
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2013-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB00475111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVT90181Medicare UPIN
NVV37342Medicare ID - Type Unspecified