Provider Demographics
NPI:1568531507
Name:RICHARDS, GARY P (DC)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:P
Last Name:RICHARDS
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 1:5765 MERLE HAY RD
Mailing Address - Street 2:BOX 384
Mailing Address - City:JOHNSTON
Mailing Address - State:IA
Mailing Address - Zip Code:50131-2810
Mailing Address - Country:US
Mailing Address - Phone:515-270-6737
Mailing Address - Fax:
Practice Address - Street 1:5765 MERLE HAY RD
Practice Address - Street 2:BOX 384
Practice Address - City:JOHNSTON
Practice Address - State:IA
Practice Address - Zip Code:50131-2810
Practice Address - Country:US
Practice Address - Phone:515-270-6737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02944111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA26073Medicare UPIN
IA26073Medicare ID - Type UnspecifiedMEDICARE NUMBER