Provider Demographics
NPI:1013050707
Name:ALBRIGHT, RICHARD MARK (DC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:MARK
Last Name:ALBRIGHT
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 1:485 DIAGONAL ST APT 11
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-0000
Mailing Address - Country:US
Mailing Address - Phone:435-673-1443
Mailing Address - Fax:
Practice Address - Street 1:20 N 400 E
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-0000
Practice Address - Country:US
Practice Address - Phone:435-673-1443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3423561202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT468770Medicare UPIN