Provider Demographics
NPI:1497852743
Name:DAVIDSON, RICHARD MICHAEL (DC, CSCS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:MICHAEL
Last Name:DAVIDSON
Suffix:
Gender:M
Credentials:DC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1449 YAMATO RD
Mailing Address - Street 2:STE 2
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-4471
Mailing Address - Country:US
Mailing Address - Phone:561-826-3808
Mailing Address - Fax:561-826-3806
Practice Address - Street 1:1449 YAMATO RD
Practice Address - Street 2:STE 2
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-4471
Practice Address - Country:US
Practice Address - Phone:561-826-3808
Practice Address - Fax:561-826-3806
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00624000111N00000X
FLCH9631111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor