Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NR0400X | Rehabilitation Chiropractor | DC003001L | PA |
Y | 111NS0005X | Chiropractic Sports Physician | DC003001L | PA |
N | 111NX0800X | Chiropractor Orthopedic Specialist | DC003001L | PA |
NPI | 1457462145 |
---|---|
Provider Name | Dr. Richard Cohen |
First Address | Kingston, PA 18704-5418 |
Second Address | Kingston, PA 18704-5418 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 09/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0011084750002 | (05) | PA |
141077 | BLUE CROSS BLUE SHIELD (01) | PA |
T29525 | (02) | PA |