Provider Demographics
NPI:1528145372
Name:DOBLE, RICHARD W JR (CHIROPRACTOR)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:W
Last Name:DOBLE
Suffix:JR
Gender:M
Credentials:CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 S MAIN ST STE 203
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-4241
Mailing Address - Country:US
Mailing Address - Phone:707-823-9355
Mailing Address - Fax:707-823-7195
Practice Address - Street 1:130 S MAIN ST STE 203
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-4241
Practice Address - Country:US
Practice Address - Phone:707-823-9355
Practice Address - Fax:707-823-7195
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC22993111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA113656514Medicare ID - Type Unspecified
CA113656514Medicare UPIN