Provider Demographics
NPI:1871682021
Name:DOLAN, RICHARD MICHAEL (DC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:MICHAEL
Last Name:DOLAN
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 1:900 VALLEJO STREET
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-5115
Mailing Address - Country:US
Mailing Address - Phone:707-545-6599
Mailing Address - Fax:707-545-1970
Practice Address - Street 1:900 VALLEJO STREET
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-5115
Practice Address - Country:US
Practice Address - Phone:707-545-6599
Practice Address - Fax:707-545-1970
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC13766111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor