Provider Demographics
NPI:1871500470
Name:KIND, RICHARD LEE (DC)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:LEE
Last Name:KIND
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 4656
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37602
Mailing Address - Country:US
Mailing Address - Phone:423-283-9683
Mailing Address - Fax:423-283-9685
Practice Address - Street 1:2312 KNOB CREEK ROAD
Practice Address - Street 2:SUITE 204
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604
Practice Address - Country:US
Practice Address - Phone:423-283-9683
Practice Address - Fax:423-283-9685
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000504111N00000X
TN504111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNT74681Medicare UPIN
3674505Medicare ID - Type Unspecified
T74681Medicare UPIN