Provider Demographics
NPI:1922230432
Name:RICHARDSON, NATHANAEL MARK (DC)
Entity Type:Individual
Prefix:DR
First Name:NATHANAEL
Middle Name:MARK
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 1:107 S COLLEGE RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-3225
Mailing Address - Country:US
Mailing Address - Phone:337-234-4987
Mailing Address - Fax:337-237-4515
Practice Address - Street 1:107 S COLLEGE RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-3225
Practice Address - Country:US
Practice Address - Phone:337-234-4987
Practice Address - Fax:337-237-4515
Is Sole Proprietor?:No
Enumeration Date:2009-08-17
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1529111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor