Provider Demographics
NPI:1730309394
Name:DR. MARC RICHARDSON CHIROPRACTIC MANAGEMENT, L.L.C.
Entity Type:Organization
Organization Name:DR. MARC RICHARDSON CHIROPRACTIC MANAGEMENT, L.L.C.
Other - Org Name:ABSOLUTE WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:512-528-1000
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:78613-9015
Practice Address - Country:US
Practice Address - Phone:512-528-1000
Practice Address - Fax:512-528-1200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2007-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00945ZMedicare PIN