Provider Demographics
NPI:1821383183
Name:RICHARDSON, THOMAS (MACOM, DIPL OM)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:MACOM, DIPL OM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2720 W MAIN ST
Mailing Address - Street 2:3B
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-8128
Mailing Address - Country:US
Mailing Address - Phone:605-484-5516
Mailing Address - Fax:
Practice Address - Street 1:2720 W MAIN ST
Practice Address - Street 2:3B
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-8128
Practice Address - Country:US
Practice Address - Phone:605-484-5516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAC372171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist