Provider Demographics
NPI:1891857504
Name:HARDESTY, RICHARD WILLIAM (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:WILLIAM
Last Name:HARDESTY
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 1:1181 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:WARMINSTER
Mailing Address - State:PA
Mailing Address - Zip Code:18974-1863
Mailing Address - Country:US
Mailing Address - Phone:215-491-9089
Mailing Address - Fax:215-491-7145
Practice Address - Street 1:1181 VALLEY RD
Practice Address - Street 2:
Practice Address - City:WARMINSTER
Practice Address - State:PA
Practice Address - Zip Code:18974-1863
Practice Address - Country:US
Practice Address - Phone:215-491-9089
Practice Address - Fax:215-491-7145
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-003719-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01207123Medicaid
PA0114662000OtherKEYSTONE HEALTH PLAN EAST
PA01207123Medicaid
PA532510Medicare ID - Type Unspecified