Provider Demographics
NPI:1427351048
Name:R.E. MCCARTHY, D.C., P.C.
Entity type:Organization
Organization Name:R.E. MCCARTHY, D.C., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:MCCARTHY
Authorized Official - Suffix:
Authorized Official - Credentials:DC, PC
Authorized Official - Phone:541-942-5486
Mailing Address - Street 1:437 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97424-2407
Mailing Address - Country:US
Mailing Address - Phone:541-942-5486
Mailing Address - Fax:542-942-9433
Practice Address - Street 1:437 S 5TH ST
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:OR
Practice Address - Zip Code:97424-2407
Practice Address - Country:US
Practice Address - Phone:541-942-5486
Practice Address - Fax:542-942-9433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-21
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27 1365111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR0000QGBMMMedicare PIN
ORT83497Medicare UPIN