Provider Demographics
NPI:1972601359
Name:DAVIDSON, RICHARD (DC)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:
Last Name:DAVIDSON
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 1:550 MAMARONECK AVE
Mailing Address - Street 2:SUITE NUMBER 103
Mailing Address - City:HARRISON
Mailing Address - State:NY
Mailing Address - Zip Code:10528-1634
Mailing Address - Country:US
Mailing Address - Phone:914-346-5200
Mailing Address - Fax:914-346-5201
Practice Address - Street 1:550 MAMARONECK AVE
Practice Address - Street 2:SUITE NUMBER 103
Practice Address - City:HARRISON
Practice Address - State:NY
Practice Address - Zip Code:10528-1634
Practice Address - Country:US
Practice Address - Phone:914-346-5200
Practice Address - Fax:914-346-5201
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX006549111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX47311Medicare PIN