Provider Demographics
NPI:1922071547
Name:PAGE, RICHARD D (CHIROPRACTOR)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:D
Last Name:PAGE
Suffix:
Gender:M
Credentials:CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2270 NE MCDANIEL LN
Mailing Address - Street 2:SUITE A
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-3247
Mailing Address - Country:US
Mailing Address - Phone:503-472-2523
Mailing Address - Fax:
Practice Address - Street 1:2270 NE MCDANIEL LN
Practice Address - Street 2:SUITE A
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-3247
Practice Address - Country:US
Practice Address - Phone:503-472-2523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5694111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO27164021OtherBLUE CROSS BLUE SHIELD