Healthcare Provider Details

I. General information

NPI: 1952499576
Provider Name (Legal Business Name): JAMES RICHARD MORT D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 HARRISON AVE
MANOR PA
15665-9721
US

IV. Provider business mailing address

PO BOX 724
MANOR PA
15665-0724
US

V. Phone/Fax

Practice location:
  • Phone: 724-863-9982
  • Fax:
Mailing address:
  • Phone: 724-863-9982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberD.C.004661L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number#543
License Number StateWV

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2284287
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerAETNA HMO
# 2
IdentifierMO480376
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerHGS
# 3
Identifier4355211
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerAETNA PPO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: