Provider Demographics
NPI:1194849729
Name:RICHARDS, DARELL HERMAN (MS DC CABCT)
Entity Type:Individual
Prefix:
First Name:DARELL
Middle Name:HERMAN
Last Name:RICHARDS
Suffix:
Gender:M
Credentials:MS DC CABCT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3313 RUE PARC FONTAINE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70131
Mailing Address - Country:US
Mailing Address - Phone:504-392-7440
Mailing Address - Fax:504-392-7440
Practice Address - Street 1:3313 RUE PARC FONTAINE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70131
Practice Address - Country:US
Practice Address - Phone:504-392-7440
Practice Address - Fax:504-392-7440
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA442111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA20365OtherBLUE CROSS
LA1953521Medicaid
LA1953521Medicaid
LA20365OtherBLUE CROSS