Provider Demographics
NPI:1881628618
Name:HUSTON, RICHARD M (DC)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:M
Last Name:HUSTON
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 1:1150 HUNGRYNECK BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3484
Mailing Address - Country:US
Mailing Address - Phone:843-884-1876
Mailing Address - Fax:843-884-1320
Practice Address - Street 1:1150 HUNGRYNECK BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3484
Practice Address - Country:US
Practice Address - Phone:843-884-1876
Practice Address - Fax:843-884-1320
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2886111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH2886Medicaid
SCAA15738598Medicare PIN
SCCH2886Medicaid