Provider Demographics
NPI:1043337298
Name:BITTNER, RICHARD JOSEPH (DC)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JOSEPH
Last Name:BITTNER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1963 MCCULLOCH BLVD N
Mailing Address - Street 2:#102
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-5700
Mailing Address - Country:US
Mailing Address - Phone:928-505-4401
Mailing Address - Fax:928-505-4402
Practice Address - Street 1:1963 MCCULLOCH BLVD N
Practice Address - Street 2:#102
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5700
Practice Address - Country:US
Practice Address - Phone:928-505-4401
Practice Address - Fax:928-505-4402
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5733111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor