Provider Demographics
NPI:1255347308
Name:RICHTER, PHILIP (DC)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:
Last Name:RICHTER
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:PO BOX 228
Mailing Address - Street 2:209 N. PIKE RD.
Mailing Address - City:SARVER
Mailing Address - State:PA
Mailing Address - Zip Code:16055-0228
Mailing Address - Country:US
Mailing Address - Phone:724-353-1310
Mailing Address - Fax:724-353-1323
Practice Address - Street 1:209 N. PIKE RD.
Practice Address - Street 2:
Practice Address - City:SARVER
Practice Address - State:PA
Practice Address - Zip Code:16055-0228
Practice Address - Country:US
Practice Address - Phone:724-353-1310
Practice Address - Fax:724-353-1323
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002649L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA640693Medicare UPIN
PA1005404Medicare UPIN
PAT27109Medicare UPIN
PARI022969Medicare ID - Type Unspecified
PA1016521Medicare UPIN
PA1379151Medicare UPIN