Provider Demographics
NPI:1386682508
Name:RICHARDSON, GREGORY PHILLIP (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:PHILLIP
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 1:564 RIDGE RD E
Mailing Address - Street 2:SUITE 209
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-1233
Mailing Address - Country:US
Mailing Address - Phone:585-544-0695
Mailing Address - Fax:585-544-8029
Practice Address - Street 1:564 RIDGE RD E
Practice Address - Street 2:SUITE 209
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-1233
Practice Address - Country:US
Practice Address - Phone:585-544-0695
Practice Address - Fax:585-544-8029
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010866111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7340610OtherAETNA PROVIDER NUMBER
NY139013ANOtherPREFERRED CARE NUMBER
NYV00753Medicare UPIN
NY7340610OtherAETNA PROVIDER NUMBER