Provider Demographics
NPI:1790826667
Name:RICHARDSON CHIROPRACTIC GROUP
Entity Type:Organization
Organization Name:RICHARDSON CHIROPRACTIC GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:M
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:337-234-4987
Mailing Address - Street 1:1304 BERTRAND DR STE F5
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-9106
Mailing Address - Country:US
Mailing Address - Phone:337-234-4987
Mailing Address - Fax:337-234-5755
Practice Address - Street 1:1304 BERTRAND DR STE F5
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-9106
Practice Address - Country:US
Practice Address - Phone:373-234-4987
Practice Address - Fax:373-234-5755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1136111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1536067Medicaid
LAT87195Medicare UPIN
LA59338Medicare ID - Type Unspecified
LAU75509Medicare UPIN
LA1536067Medicaid