Provider Demographics
NPI:1861692998
Name:MCPHERSON, RICHARD DALE (DC)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:DALE
Last Name:MCPHERSON
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 1:4107 TAYLOR BLVD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40215-2371
Mailing Address - Country:US
Mailing Address - Phone:502-364-7246
Mailing Address - Fax:502-364-7245
Practice Address - Street 1:4107 TAYLOR BLVD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40215-2371
Practice Address - Country:US
Practice Address - Phone:502-364-7246
Practice Address - Fax:502-364-7245
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN80001714-A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100382820Medicaid
IN200871690Medicaid
KYK163800OtherMEDICARE PTAN
INU59404Medicare UPIN
KY7100382820Medicaid