Provider Demographics
NPI:1326114810
Name:RICHARDSON, DARYL (DC)
Entity Type:Individual
Prefix:DR
First Name:DARYL
Middle Name:
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 1:44855 SAN PABLO AVE
Mailing Address - Street 2:STE. 4 & 5
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-3530
Mailing Address - Country:US
Mailing Address - Phone:760-568-2725
Mailing Address - Fax:760-568-1967
Practice Address - Street 1:44855 SAN PABLO AVE
Practice Address - Street 2:STE. 4 & 5
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-3530
Practice Address - Country:US
Practice Address - Phone:760-568-2725
Practice Address - Fax:760-568-1967
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23963111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0239630Medicare ID - Type Unspecified