Provider Demographics
NPI:1912003237
Name:ENDRIS, RICHARD JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JOHN
Last Name:ENDRIS
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 1:1560 LIVINGSTON AVENUE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WEST SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55118
Mailing Address - Country:US
Mailing Address - Phone:651-451-2229
Mailing Address - Fax:651-457-5540
Practice Address - Street 1:1560 LIVINGSTON AVE STE 103
Practice Address - Street 2:
Practice Address - City:WEST SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55118-3428
Practice Address - Country:US
Practice Address - Phone:651-451-2229
Practice Address - Fax:651-457-5540
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN003194111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN681324100Medicaid
MN681324100Medicaid
MN681324100Medicare UPIN