Richard T Miner, D.C.
Individual provider Active NPI Chiropractor · Gualala, CA
NPI 1174658298 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1174658298
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- DC16750 (CA)
- Practice address
- 38690 Pacific Dr.
Suite 3
Gualala, CA 95445 - Phone
- (707) 884-1714
- NPI assigned
- Feb 22, 2007
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110406000596 | CA | Practitioner - Chiropractic | 3274717814 | Practice locations: Auburn, CA; Nevada City, CA |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DC16750 | CA | MD | Chiropractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | DC16750 | CA | Yes |
Addresses
Primary practice location
38690 Pacific Dr.
Suite 3
Gualala, CA 95445
Mailing address
PO Box 409
38690 Pacific Dr.
Gualala, CA 95445-0409
Phone (707) 884-1714
Other providers in Gualala, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.