Healthcare Provider Details

I. General information

NPI: 1710023734
Provider Name (Legal Business Name): JOHN P. RICHARDS, D.O.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4914 ELK RIVER RD STE A
ELKVIEW WV
25071-9278
US

IV. Provider business mailing address

4914 ELK RIVER RD STE A
ELKVIEW WV
25071-9278
US

V. Phone/Fax

Practice location:
  • Phone: 304-965-7051
  • Fax: 304-965-5074
Mailing address:
  • Phone: 304-965-7051
  • Fax: 304-965-5074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1129
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number1129
License Number StateWV
# 3
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number1129
License Number StateWV

VIII. Authorized Official

Name: JOHN P. RICHARDS
Title or Position: OWNER
Credential: D.O.
Phone: 304-965-7051