Provider Demographics
NPI:1326130352
Name:RICKY-STRADFORD, MARY M (DC)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:M
Last Name:RICKY-STRADFORD
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 1:402 W PINE ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:RAYMORE
Mailing Address - State:MO
Mailing Address - Zip Code:64083-9691
Mailing Address - Country:US
Mailing Address - Phone:816-331-8200
Mailing Address - Fax:816-331-9112
Practice Address - Street 1:402 W PINE ST
Practice Address - Street 2:SUITE F
Practice Address - City:RAYMORE
Practice Address - State:MO
Practice Address - Zip Code:64083-9075
Practice Address - Country:US
Practice Address - Phone:816-331-8200
Practice Address - Fax:816-331-9112
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO005146111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor