Provider Demographics
NPI:1891763116
Name:LANDECK, RICHARD EDWIN (DC, CAD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:EDWIN
Last Name:LANDECK
Suffix:
Gender:M
Credentials:DC, CAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631 ALLENWOOD LOOP
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162-1004
Mailing Address - Country:US
Mailing Address - Phone:352-552-4163
Mailing Address - Fax:
Practice Address - Street 1:631 ALLENWOOD LOOP
Practice Address - Street 2:HOUSE CALLS ONLY NOT AT THIS LOCATION
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-1004
Practice Address - Country:US
Practice Address - Phone:352-552-4163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-11
Last Update Date:2007-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0005652111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL22133Medicare ID - Type Unspecified
FLT94005Medicare UPIN