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NPI Code Detail

MEDICARE: DR. KEITH CHARLES RICHARD D.C.

MEDICARE:  DR. KEITH CHARLES RICHARD  D.C.
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
1111N00000XChiropractorCH7396FL
2111N00000XChiropractor038010561IL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3AD239OTHERFLMEDICARE GROUP ID

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
255689OTHERBCBS

General Provider Information

NPI Number : 1245399054
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KEITH CHARLES RICHARD D.C.
Provider Business Mailing Address
First Line : 138 S OAK AVE
Second Line :
City : BARTLETT
State : IL
Zip : 60103-6620
Country : US
Telephone Number : 630-830-1500
Fax Number : 630-830-2513
Provider Business Practice Location Address
First Line : 138 S OAK AVE
Second Line :
City : BARTLETT
State : IL
Zip : 60103-6620
Country : US
Telephone Number : 630-830-1500
Fax Number : 630-830-2513
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/07/2006
Last Update Date : 07/26/2012

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Directions to “ DR. KEITH CHARLES RICHARD D.C.” Practice Location

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