Healthcare Provider Details

I. General information

NPI: 1174710677
Provider Name (Legal Business Name): RICHERT CHIROPRACTIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2007
Last Update Date: 09/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 PROFESSIONAL PARK DR
NEW HAVEN IN
46774-1995
US

IV. Provider business mailing address

610 PROFESSIONAL PARK DR
NEW HAVEN IN
46774-1995
US

V. Phone/Fax

Practice location:
  • Phone: 260-749-2225
  • Fax:
Mailing address:
  • Phone: 260-749-2225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberIN08001598A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberIN08001598A
License Number StateIN

VIII. Authorized Official

Name: MS. ANITA A RICHERT
Title or Position: CFO
Credential: CPA
Phone: 260-749-2225