Provider Demographics
NPI:1336286657
Name:GUIDRY, RICHARD I JR (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:I
Last Name:GUIDRY
Suffix:JR
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 1:2825 WILCREST DR
Mailing Address - Street 2:#607
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77042-3391
Mailing Address - Country:US
Mailing Address - Phone:713-780-0788
Mailing Address - Fax:713-975-1717
Practice Address - Street 1:2825 WILCREST DR
Practice Address - Street 2:#607
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77042-3391
Practice Address - Country:US
Practice Address - Phone:713-780-0788
Practice Address - Fax:713-975-1717
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8045111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX66031Medicare ID - Type Unspecified