MEDICARE: ROBERT JEWELL RICHARDSON DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	004392	MO

General Provider Information

NPI Number	:	1265443881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT JEWELL RICHARDSON DC

Provider Business Mailing Address
First Line	:	836 STATE HIGHWAY Y
Second Line	:
City	:	GALENA
State	:	MO
Zip	:	65656-4633
Country	:	US
Telephone Number	:	417-272-8317
Fax Number	:

Provider Business Practice Location Address
First Line	:	836 STATE HIGHWAY Y
Second Line	:
City	:	GALENA
State	:	MO
Zip	:	65656-4633
Country	:	US
Telephone Number	:	417-272-8317
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	07/08/2007

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