Provider Demographics
NPI:1053559567
Name:MERCADANTE, RICHARD D (DC)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:D
Last Name:MERCADANTE
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 1:1821 BRIARWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:JAMISON
Mailing Address - State:PA
Mailing Address - Zip Code:18929-1329
Mailing Address - Country:US
Mailing Address - Phone:215-491-9425
Mailing Address - Fax:
Practice Address - Street 1:1821 BRIARWOOD CIR
Practice Address - Street 2:
Practice Address - City:JAMISON
Practice Address - State:PA
Practice Address - Zip Code:18929-1329
Practice Address - Country:US
Practice Address - Phone:215-491-9425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-22
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003277L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1982866711OtherGROUP IDENTIFIER