Provider Demographics
NPI:1790905560
Name:HUDDLESTON, RICHARD P (DC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:P
Last Name:HUDDLESTON
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 1:1706 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94559-1703
Mailing Address - Country:US
Mailing Address - Phone:707-252-7766
Mailing Address - Fax:707-252-7771
Practice Address - Street 1:1706 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94559-1703
Practice Address - Country:US
Practice Address - Phone:707-252-7766
Practice Address - Fax:707-252-7771
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18456111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0184560Medicare ID - Type Unspecified