Provider Demographics
NPI:1124044391
Name:RICHARDSON, JUDITH H (DC)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:H
Last Name:RICHARDSON
Suffix:
Gender:F
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:PO BOX 280
Mailing Address - Street 2:
Mailing Address - City:SEABROOK
Mailing Address - State:TX
Mailing Address - Zip Code:77586-0280
Mailing Address - Country:US
Mailing Address - Phone:281-326-4980
Mailing Address - Fax:
Practice Address - Street 1:3140 NASA PKWY
Practice Address - Street 2:
Practice Address - City:SEABROOK
Practice Address - State:TX
Practice Address - Zip Code:77586-6465
Practice Address - Country:US
Practice Address - Phone:281-326-4980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX4738111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT62131Medicare UPIN
TX602001Medicare ID - Type Unspecified