MEDICARE: DR. RICHARD C DOEDE D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CH00001351	WA
2	111N00000X	Chiropractor	1557	OR
3	111N00000X	Chiropractor	C-510	ID

General Provider Information

NPI Number	:	1184659013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD C DOEDE D.C.

Provider Business Mailing Address
First Line	:	8919 E BROADWAY AVE
Second Line	:
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99212-2719
Country	:	US
Telephone Number	:	509-924-7374
Fax Number	:	509-927-8896

Provider Business Practice Location Address
First Line	:	8919 E BROADWAY AVE
Second Line	:
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99212-2719
Country	:	US
Telephone Number	:	509-924-7374
Fax Number	:	509-927-8896

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	08/03/2012

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