Provider Demographics
NPI:1821075524
Name:BOATRIGHT, RICHARD ALBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ALBERT
Last Name:BOATRIGHT
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:PO BOX 3330
Mailing Address - Street 2:
Mailing Address - City:PINETOP
Mailing Address - State:AZ
Mailing Address - Zip Code:85935-3330
Mailing Address - Country:US
Mailing Address - Phone:928-367-4402
Mailing Address - Fax:928-367-4403
Practice Address - Street 1:43 W WHITE MOUNTAIN BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:PINETOP
Practice Address - State:AZ
Practice Address - Zip Code:85935-7060
Practice Address - Country:US
Practice Address - Phone:928-367-4402
Practice Address - Fax:928-367-4403
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5129111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U19395Medicare UPIN
69965Medicare ID - Type Unspecified