Healthcare Provider Details

I. General information

NPI: 1417922378
Provider Name (Legal Business Name): MARCUS K RICHESON DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 08/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15043 MAIN ST
ALACHUA FL
32615-3637
US

IV. Provider business mailing address

15043 MAIN ST
ALACHUA FL
32615-3637
US

V. Phone/Fax

Practice location:
  • Phone: 386-462-5886
  • Fax: 386-462-4668
Mailing address:
  • Phone: 386-462-5886
  • Fax: 386-462-4668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCM8258
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: