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General NPI Number Information
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NPI Number | 1245783778
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Entity Type | Organization
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Legal Business Name | RICHARDS CHIROPRACTIC LLC
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Dates
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Enumeration Date | 08/02/2016
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Last Update Date | 08/02/2016
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Provider Practice Location Address
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Address Line | 16645 W GREENFIELD AVE SUITE D
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City | NEW BERLIN
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State | WI
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Zip | 53151-1424
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Country | US
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Telephone | 262-788-5940
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Fax | 262-788-5986
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Provider Business Mailing Address
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Address Line | 16645 W GREENFIELD AVE SUITE D
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City | NEW BERLIN
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State | WI
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Zip | 53151-1424
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Country | US
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Telephone | 262-788-5940
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Fax | 262-788-5986
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. JESSICA LYNN RICHARDS
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Credential |
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Telephone | 262-788-5940
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 5198-12
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License Number State | WI
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