MEDICARE: DR. NATHANAEL MARK RICHARDSON 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
1	111N00000X	Chiropractor	1529	LA

General Provider Information

NPI Number	:	1922230432
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NATHANAEL MARK RICHARDSON D.C.

Provider Business Mailing Address
First Line	:	107 S COLLEGE RD
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70503-3225
Country	:	US
Telephone Number	:	337-234-4987
Fax Number	:	337-237-4515

Provider Business Practice Location Address
First Line	:	107 S COLLEGE RD
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70503-3225
Country	:	US
Telephone Number	:	337-234-4987
Fax Number	:	337-237-4515

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

Provider Enumeration Date	:	08/17/2009
Last Update Date	:	08/17/2009

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