Provider Demographics
NPI:1356360275
Name:RICHIE, LOREN W (DC)
Entity type:Individual
Prefix:DR
First Name:LOREN
Middle Name:W
Last Name:RICHIE
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 1:2205 WABASH AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-5354
Mailing Address - Country:US
Mailing Address - Phone:217-698-2779
Mailing Address - Fax:217-698-7504
Practice Address - Street 1:2205 WABASH AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-5354
Practice Address - Country:US
Practice Address - Phone:217-698-2779
Practice Address - Fax:217-698-7504
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038008580111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00344945OtherRAILROAD MEDICARE
IL488220Medicare ID - Type Unspecified
ILU72096Medicare UPIN