Healthcare Provider Details

I. General information

NPI: 1386682508
Provider Name (Legal Business Name): GREGORY PHILLIP RICHARDSON D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

564 RIDGE RD E SUITE 209
ROCHESTER NY
14621-1233
US

IV. Provider business mailing address

564 RIDGE RD E SUITE 209
ROCHESTER NY
14621-1233
US

V. Phone/Fax

Practice location:
  • Phone: 585-544-0695
  • Fax: 585-544-8029
Mailing address:
  • Phone: 585-544-0695
  • Fax: 585-544-8029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX010866
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: