Provider Demographics
NPI:1902968431
Name:QUAL, RICHARD W (DOCTOR OF CHIROPRACT)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:W
Last Name:QUAL
Suffix:
Gender:M
Credentials:DOCTOR OF CHIROPRACT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 10TH ST SE
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:ND
Mailing Address - Zip Code:58401
Mailing Address - Country:US
Mailing Address - Phone:701-252-4700
Mailing Address - Fax:701-252-2755
Practice Address - Street 1:805 10TH ST SE
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:ND
Practice Address - Zip Code:58401
Practice Address - Country:US
Practice Address - Phone:701-252-4700
Practice Address - Fax:701-252-2755
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND524111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND16870Medicaid
ND11142OtherBC BS
NDN11142Medicare PIN
ND16870Medicaid