Provider Demographics
NPI:1154951408
Name:BINGHAM, RICHARD DONALD (DC)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:DONALD
Last Name:BINGHAM
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:PO BOX 1174
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:AK
Mailing Address - Zip Code:99574-1174
Mailing Address - Country:US
Mailing Address - Phone:907-424-3535
Mailing Address - Fax:907-424-3545
Practice Address - Street 1:622 1ST STREET
Practice Address - Street 2:201
Practice Address - City:CORDOVA
Practice Address - State:AK
Practice Address - Zip Code:99574
Practice Address - Country:US
Practice Address - Phone:907-424-3535
Practice Address - Fax:907-434-3545
Is Sole Proprietor?:No
Enumeration Date:2020-01-24
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK153358111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor