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General NPI Number Information
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NPI Number | 1740840271
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Entity Type | Individual
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Provider Name | NATALIE ROSE RICHARDS DC
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Gender | Female
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Dates
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Enumeration Date | 06/17/2019
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Last Update Date | 12/26/2019
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Provider Practice Location Address
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Address Line | 5875 E RIVERSIDE BLVD STE 115
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City | ROCKFORD
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State | IL
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Zip | 61114-4937
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Country | US
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Telephone | 815-742-0987
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Fax |
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Provider Business Mailing Address
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Address Line | 5595 PORTER RD
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City | ROCKFORD
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State | IL
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Zip | 61101-7273
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Country | US
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Telephone | 815-742-0987
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 038.013360
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License Number State | IL
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