Provider Demographics
NPI:1629082276
Name:RICHARDSON, MARC (DC)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:
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 1:601 E WHITESTONE BLVD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-9022
Mailing Address - Country:US
Mailing Address - Phone:512-528-1000
Mailing Address - Fax:512-528-1200
Practice Address - Street 1:601 E WHITESTONE BLVD
Practice Address - Street 2:SUITE 230
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-9022
Practice Address - Country:US
Practice Address - Phone:512-528-1000
Practice Address - Fax:512-528-1200
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9037111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXV06383Medicare UPIN
TX8F1964Medicare PIN