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NPI Code Detail

MEDICARE: DR. RICHARD D SHADE DC

MEDICARE: DR. RICHARD D SHADE DC
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
1111N00000XChiropractorX010861-1NY

General Provider Information

NPI Number : 1326148313
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RICHARD D SHADE DC
Provider Business Mailing Address
First Line : 513 HIGHWAY 17 N
Second Line :
City : NORTH MYRTLE BEACH
State : SC
Zip : 29582-2903
Country : US
Telephone Number : 843-280-7000
Fax Number : 843-280-7001
Provider Business Practice Location Address
First Line : 513 HIGHWAY 17 N
Second Line :
City : NORTH MYRTLE BEACH
State : SC
Zip : 29582-2903
Country : US
Telephone Number : 843-280-7000
Fax Number : 843-280-7001
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/22/2006
Last Update Date : 02/28/2022

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Directions to “ DR. RICHARD D SHADE DC” Practice Location

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