Healthcare Provider Details

I. General information

NPI: 1275592438
Provider Name (Legal Business Name): TRACY M RICHARDSON D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 09/25/2023
Certification Date: 09/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1304 BERTRAND DR STE F5
LAFAYETTE LA
70506-9106
US

IV. Provider business mailing address

1304 BERTRAND DR STE F5
LAFAYETTE LA
70506-9106
US

V. Phone/Fax

Practice location:
  • Phone: 337-234-4987
  • Fax: 337-234-5755
Mailing address:
  • Phone: 337-234-4987
  • Fax: 337-234-5755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1136
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: