Provider Demographics
NPI:1821089509
Name:HEALY, RICHARD CHARLES (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:CHARLES
Last Name:HEALY
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 1:27 ROXBURY RD
Mailing Address - Street 2:
Mailing Address - City:DUMONT
Mailing Address - State:NJ
Mailing Address - Zip Code:07628-1119
Mailing Address - Country:US
Mailing Address - Phone:201-390-4252
Mailing Address - Fax:201-384-7843
Practice Address - Street 1:312 SAINT NICHOLAS AVENUE
Practice Address - Street 2:
Practice Address - City:HAWORTH
Practice Address - State:NJ
Practice Address - Zip Code:07641-1829
Practice Address - Country:US
Practice Address - Phone:201-390-4252
Practice Address - Fax:201-384-7843
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00176900111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0017535OtherGHI
NJ0495066OtherAETNA
NJRHOX385410OtherEMPIRE BC/BS
NJ2008904Medicaid
NJ199281OtherUNITEDHEALTHCARE
NJP1489232OtherOXFORD
NJ455773Medicare ID - Type Unspecified
NJ0017535OtherGHI