Provider Demographics
NPI:1821221649
Name:RICHARDS, JEFF (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFF
Middle Name:
Last Name:RICHARDS
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 1:3601 N COUNTY ROAD H
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53548-8107
Mailing Address - Country:US
Mailing Address - Phone:608-728-4973
Mailing Address - Fax:
Practice Address - Street 1:825 BROWN SCHOOL ROAD
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:WI
Practice Address - Zip Code:53536
Practice Address - Country:US
Practice Address - Phone:608-728-4973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-27
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4523-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor