Provider Demographics
NPI:1609943653
Name:RICHARD, ALVIN JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:ALVIN
Middle Name:JOSEPH
Last Name:RICHARD
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 1:2000 PANTHER LN
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:TX
Mailing Address - Zip Code:77575-3227
Mailing Address - Country:US
Mailing Address - Phone:936-334-0004
Mailing Address - Fax:936-334-0010
Practice Address - Street 1:2000 PANTHER LN
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:TX
Practice Address - Zip Code:77575-3227
Practice Address - Country:US
Practice Address - Phone:936-334-0004
Practice Address - Fax:936-334-0010
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9198111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8J1260OtherBC/BS OF TEXAS
TX181646401Medicaid
TX8J1260OtherBC/BS OF TEXAS
TXU95319Medicare UPIN