Provider Demographics
NPI:1396896924
Name:MASON, RICHARD D (DC)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:D
Last Name:MASON
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 1:727 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:PA
Mailing Address - Zip Code:15066-1829
Mailing Address - Country:US
Mailing Address - Phone:724-843-0240
Mailing Address - Fax:724-843-0259
Practice Address - Street 1:727 3RD AVE
Practice Address - Street 2:
Practice Address - City:NEW BRIGHTON
Practice Address - State:PA
Practice Address - Zip Code:15066-1829
Practice Address - Country:US
Practice Address - Phone:724-843-0240
Practice Address - Fax:724-843-0259
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001537L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006446070002Medicaid
PA0006446070002Medicaid
T29678Medicare UPIN