MEDICARE: MERCEDES RICHARD 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	111NS0005X	Sports Physician Chiropractor	16846	TX

General Provider Information

NPI Number	:	1730027277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MERCEDES RICHARD DC

Provider Business Mailing Address
First Line	:	800 W AIRPORT FWY
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75062-6312
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 W AIRPORT FWY
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75062-6312
Country	:	US
Telephone Number	:	972-636-5727
Fax Number	:

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

Provider Enumeration Date	:	03/24/2026
Last Update Date	:	03/24/2026

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