Healthcare Provider Details

I. General information

NPI: 1407860810
Provider Name (Legal Business Name): PHILLIP DAVID RICHARDSON RDH, DOM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: PHILLIP DAVID RICHARDSON RDH, DOM

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 ENCINO PLACE NE SUITE 7
ALBUQUERQUE NM
87102
US

IV. Provider business mailing address

717 ENCINO PLACE NE SUITE 7
ALBUQUERQUE NM
87102
US

V. Phone/Fax

Practice location:
  • Phone: 505-843-9636
  • Fax: 505-843-6277
Mailing address:
  • Phone: 505-843-9636
  • Fax: 505-843-6277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number800
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: