Provider Demographics
NPI:1821381781
Name:RICHARDSON, LANCE GARRETT (DC)
Entity Type:Individual
Prefix:DR
First Name:LANCE
Middle Name:GARRETT
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:PO BOX 1224
Mailing Address - Street 2:
Mailing Address - City:MENA
Mailing Address - State:AR
Mailing Address - Zip Code:71953-1224
Mailing Address - Country:US
Mailing Address - Phone:479-385-9693
Mailing Address - Fax:844-222-7880
Practice Address - Street 1:601 HIGHWAY 71 N STE W
Practice Address - Street 2:
Practice Address - City:MENA
Practice Address - State:AR
Practice Address - Zip Code:71953-4394
Practice Address - Country:US
Practice Address - Phone:479-385-9693
Practice Address - Fax:844-222-7880
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-25
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR16049111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR233571718Medicaid