MEDICARE: DR. RICHARD WISE PROSSER 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
1	111N00000X	Chiropractor	1405	NC

General Provider Information

NPI Number	:	1639369929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD WISE PROSSER DC

Provider Business Mailing Address
First Line	:	PO BOX 16411
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28297-6411
Country	:	US
Telephone Number	:	704-376-8666
Fax Number	:

Provider Business Practice Location Address
First Line	:	845 CHURCH ST N
Second Line	:	SUIE 210
City	:	CONCORD
State	:	NC
Zip	:	28025-4300
Country	:	US
Telephone Number	:	704-376-8666
Fax Number	:

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

Provider Enumeration Date	:	08/01/2007
Last Update Date	:	06/14/2026

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