Provider Demographics
NPI:1922299205
Name:RICHARDSON, SCOTT (DAOM)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:DAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2165 S GRANT ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-4425
Mailing Address - Country:US
Mailing Address - Phone:619-861-8287
Mailing Address - Fax:
Practice Address - Street 1:1872 S PEARL ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-3137
Practice Address - Country:US
Practice Address - Phone:720-665-7127
Practice Address - Fax:720-222-5555
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1756171100000X
CAAC12620171100000X
CA27724225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist