Provider Demographics
NPI:1881805117
Name:MAY, RICHARD JOSEPH (DC)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JOSEPH
Last Name:MAY
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 1:21 W COMMERCE DRIVE
Mailing Address - Street 2:STE B
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-9289
Mailing Address - Country:US
Mailing Address - Phone:208-772-4545
Mailing Address - Fax:208-772-4550
Practice Address - Street 1:21 W COMMERCE DRIVE
Practice Address - Street 2:STE B
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-9289
Practice Address - Country:US
Practice Address - Phone:208-772-4545
Practice Address - Fax:208-772-4550
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA1245111N00000X
IDCHIA-1245111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807750800Medicaid