Provider Demographics
NPI:1457402026
Name:RICHARD D. MASON
Entity Type:Organization
Organization Name:RICHARD D. MASON
Other - Org Name:MASON CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:D
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:724-843-0240
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:724-843-0240
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001537L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006445360002Medicaid
PA0006445360002Medicaid