Provider Demographics
NPI:1922246917
Name:VANCE, RICHARD B (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:B
Last Name:VANCE
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 1:8705 SHOAL CREEK BLVD
Mailing Address - Street 2:SUITE 107C
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-6802
Mailing Address - Country:US
Mailing Address - Phone:512-200-6570
Mailing Address - Fax:
Practice Address - Street 1:8705 SHOAL CREEK BLVD
Practice Address - Street 2:SUITE 107C
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-6802
Practice Address - Country:US
Practice Address - Phone:512-200-6570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-28
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4039111N00000X, 111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT16392Medicare UPIN