Provider Demographics
NPI:1043296221
Name:RICHEY, BRIAN TROY (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:TROY
Last Name:RICHEY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 S 1470 E
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-1745
Mailing Address - Country:US
Mailing Address - Phone:435-652-4476
Mailing Address - Fax:435-674-2408
Practice Address - Street 1:107 S 1470 E
Practice Address - Street 2:SUITE 102
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-1745
Practice Address - Country:US
Practice Address - Phone:435-652-4476
Practice Address - Fax:435-674-2408
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5234883-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU98071Medicare UPIN
UT005579603Medicare ID - Type Unspecified