Provider Demographics
NPI:1053313502
Name:MCCARTHY, RICHARD E (DC, PC)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:E
Last Name:MCCARTHY
Suffix:
Gender:M
Credentials:DC, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:437 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97424-2407
Mailing Address - Country:US
Mailing Address - Phone:541-942-5486
Mailing Address - Fax:541-942-9433
Practice Address - Street 1:437 S 5TH ST
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:OR
Practice Address - Zip Code:97424-2407
Practice Address - Country:US
Practice Address - Phone:541-942-5486
Practice Address - Fax:541-942-9433
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27 1365111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORT83497Medicare UPIN
ORR0000QGBMMMedicare ID - Type Unspecified