Healthcare Provider Details

I. General information

NPI: 1043391634
Provider Name (Legal Business Name): RICHARD G MASON D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 10/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11580 OVERLOOK DR 200
FISHERS IN
46037-4212
US

IV. Provider business mailing address

11580 OVERLOOK DR 200
FISHERS IN
46037-4212
US

V. Phone/Fax

Practice location:
  • Phone: 317-577-9558
  • Fax: 317-577-9559
Mailing address:
  • Phone: 317-577-9558
  • Fax: 317-577-9559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08002072A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: