Provider Demographics
NPI:1164759874
Name:BIRD, RICHARD S (DC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:S
Last Name:BIRD
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 1:4739 S CONWAY RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32812-1259
Mailing Address - Country:US
Mailing Address - Phone:407-260-8879
Mailing Address - Fax:321-594-5809
Practice Address - Street 1:625 S RONALD REAGAN BLVD
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-5470
Practice Address - Country:US
Practice Address - Phone:407-260-8879
Practice Address - Fax:321-594-5809
Is Sole Proprietor?:No
Enumeration Date:2009-11-17
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH5219111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor