Provider Demographics
NPI:1548488042
Name:DR. RICHARD W. MCCANN JR.
Entity type:Organization
Organization Name:DR. RICHARD W. MCCANN JR.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:WALTER
Authorized Official - Last Name:MCCANN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:770-587-2663
Mailing Address - Street 1:2500 OLD ALABAMA RD
Mailing Address - Street 2:SUITE 19
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-2400
Mailing Address - Country:US
Mailing Address - Phone:770-587-2663
Mailing Address - Fax:770-587-9110
Practice Address - Street 1:2500 OLD ALABAMA RD
Practice Address - Street 2:SUITE 19
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-2400
Practice Address - Country:US
Practice Address - Phone:770-587-2663
Practice Address - Fax:770-587-9110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR005444111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCDVPMedicare ID - Type Unspecified