Provider Demographics
NPI:1992908685
Name:EBBRECHT, RICHARD FREDERICK (DC)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:FREDERICK
Last Name:EBBRECHT
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 1:45 SYLVAN AVE
Mailing Address - Street 2:
Mailing Address - City:MILLER PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11764-1929
Mailing Address - Country:US
Mailing Address - Phone:631-331-3621
Mailing Address - Fax:631-331-3621
Practice Address - Street 1:45 SYLVAN AVE
Practice Address - Street 2:
Practice Address - City:MILLER PLACE
Practice Address - State:NY
Practice Address - Zip Code:11764-1929
Practice Address - Country:US
Practice Address - Phone:631-331-3621
Practice Address - Fax:631-331-3621
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX-010189111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor