Provider Demographics
NPI:1326071929
Name:RICHESON, MICAH T (DC)
Entity Type:Individual
Prefix:
First Name:MICAH
Middle Name:T
Last Name:RICHESON
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 1:2304 CRESTOVER LN STE 102
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-6788
Mailing Address - Country:US
Mailing Address - Phone:813-994-5455
Mailing Address - Fax:813-994-4656
Practice Address - Street 1:2304 CRESTOVER LN STE 102
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-6788
Practice Address - Country:US
Practice Address - Phone:813-994-5455
Practice Address - Fax:813-994-4656
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0008354111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U89600Medicare UPIN
701412Medicare ID - Type Unspecified