Provider Demographics
NPI:1538223011
Name:CHANEY, RICHARD ROSS (DC)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ROSS
Last Name:CHANEY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1125 VILLA LINDE CT
Mailing Address - Street 2:SUITE 40
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3410
Mailing Address - Country:US
Mailing Address - Phone:810-720-2200
Mailing Address - Fax:810-720-1440
Practice Address - Street 1:1125 VILLA LINDE CT
Practice Address - Street 2:SUITE 40
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3410
Practice Address - Country:US
Practice Address - Phone:810-720-2200
Practice Address - Fax:810-720-1440
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301002888111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
11273433OtherCAQH
MI0B51466OtherBCBS
MIT32764Medicare UPIN
MI0B51466OtherBCBS