Provider Demographics
NPI:1265443881
Name:RICHARDSON, ROBERT JEWELL (DC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JEWELL
Last Name:RICHARDSON
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 1:836 STATE HIGHWAY Y
Mailing Address - Street 2:
Mailing Address - City:GALENA
Mailing Address - State:MO
Mailing Address - Zip Code:65656-4633
Mailing Address - Country:US
Mailing Address - Phone:417-272-8317
Mailing Address - Fax:
Practice Address - Street 1:836 STATE HIGHWAY Y
Practice Address - Street 2:
Practice Address - City:GALENA
Practice Address - State:MO
Practice Address - Zip Code:65656-4633
Practice Address - Country:US
Practice Address - Phone:417-272-8317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004392111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor