Provider Demographics
NPI:1306871058
Name:HEBERT, RICHARD (DC)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:HEBERT
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 1:1425 NE REVERE AVE
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-4160
Mailing Address - Country:US
Mailing Address - Phone:541-382-9595
Mailing Address - Fax:541-382-9595
Practice Address - Street 1:1425 NE REVERE AVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4160
Practice Address - Country:US
Practice Address - Phone:541-382-9595
Practice Address - Fax:541-382-9595
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OROR-2548111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR109310Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
OR109309Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
ORU52145Medicare UPIN