Provider Demographics
NPI:1245804624
Name:WHITEHEAD, RICHELLE RAE (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHELLE
Middle Name:RAE
Last Name:WHITEHEAD
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 1:1226 E JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-7908
Mailing Address - Country:US
Mailing Address - Phone:208-540-0883
Mailing Address - Fax:
Practice Address - Street 1:405 S 8TH ST STE 290
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-7100
Practice Address - Country:US
Practice Address - Phone:208-342-7136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-19
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-2045111NP0017X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor