Provider Demographics
NPI:1730184292
Name:DOOM, RICHARD ALLEN (DC)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ALLEN
Last Name:DOOM
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 E BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43605-2354
Mailing Address - Country:US
Mailing Address - Phone:419-693-0721
Mailing Address - Fax:419-693-9596
Practice Address - Street 1:431 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43605-2354
Practice Address - Country:US
Practice Address - Phone:419-693-0721
Practice Address - Fax:419-693-9596
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-20
Last Update Date:2008-05-16
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-04-03
Provider Licenses
StateLicense IDTaxonomies
OH2719111N00000X
MI2301007692111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2087272Medicaid
OH73691Medicare UPIN
OH2087272Medicaid