Provider Demographics
NPI:1275592438
Name:RICHARDSON, TRACY M (DC)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:M
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 1:1304 BERTRAND DR STE F5
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-9106
Mailing Address - Country:US
Mailing Address - Phone:337-234-4987
Mailing Address - Fax:337-234-5755
Practice Address - Street 1:1304 BERTRAND DR STE F5
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-9106
Practice Address - Country:US
Practice Address - Phone:337-234-4987
Practice Address - Fax:337-234-5755
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1136111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1536067Medicaid
LA1536067Medicaid
LA5X867Medicare ID - Type Unspecified