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General NPI Number Information
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NPI Number | 1366108235
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Entity Type | Organization
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Legal Business Name | RICH MOUNTAIN CHIROPRACTIC, PLLC
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Dates
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Enumeration Date | 11/15/2021
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Last Update Date | 10/05/2022
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Provider Practice Location Address
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Address Line | 601 HIGHWAY 71 N STE W
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City | MENA
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State | AR
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Zip | 71953-4394
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Country | US
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Telephone | 479-365-9660
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Fax | 844-222-7880
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Provider Business Mailing Address
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Address Line | PO BOX 1224
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City | MENA
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State | AR
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Zip | 71953-1224
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Country | US
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Telephone | 479-365-9660
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Fax | 844-222-7880
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Authorized Official
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Title or Position | OWNER
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Name | DR. LANCE GARRETT RICHARDSON
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Credential | DC
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Telephone | 479-385-9693
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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