Provider Demographics
NPI:1124143078
Name:KETTERING, RICHARD L (DC)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:L
Last Name:KETTERING
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 1:1601 COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-4528
Mailing Address - Country:US
Mailing Address - Phone:717-290-7177
Mailing Address - Fax:717-290-1148
Practice Address - Street 1:1601 COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-4528
Practice Address - Country:US
Practice Address - Phone:717-290-7177
Practice Address - Fax:717-290-1148
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001950L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor