Provider Demographics
NPI:1194732768
Name:KLEIN, RICHARD S (DC PA)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:S
Last Name:KLEIN
Suffix:
Gender:M
Credentials:DC PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23008 SANDALFOOT PLAZA DRIVE
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428
Mailing Address - Country:US
Mailing Address - Phone:561-483-9955
Mailing Address - Fax:561-483-9954
Practice Address - Street 1:23008 SANDALFOOT PLAZA DR
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428
Practice Address - Country:US
Practice Address - Phone:561-483-9955
Practice Address - Fax:561-483-9954
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0004464111N00000X
FLCH4464111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL050260000Medicaid
FLT54992Medicare UPIN