Provider Demographics
NPI:1972601292
Name:RICHARDS, JACQUELINE JEAN (DC)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:JEAN
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 JORDAN LN NW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35805-2619
Mailing Address - Country:US
Mailing Address - Phone:256-837-5930
Mailing Address - Fax:
Practice Address - Street 1:201 JORDAN LN NW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35805-2619
Practice Address - Country:US
Practice Address - Phone:256-837-5930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL 1793111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor