Provider Demographics
NPI:1740237700
Name:RICHARDSON, GARY L (DC)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:L
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 1:1244 HARTNELL AVE STE B
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-2229
Mailing Address - Country:US
Mailing Address - Phone:530-222-3727
Mailing Address - Fax:530-222-4474
Practice Address - Street 1:1244 HARTNELL AVE STE B
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-2229
Practice Address - Country:US
Practice Address - Phone:530-222-3727
Practice Address - Fax:530-222-4474
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23577111N00000X
CADC23577111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC23577OtherCA LICENSE #
CA350051571OtherRAILROAD MEDICARE PIN
CADC23577OtherCA LICENSE #
CAU54506Medicare UPIN