Provider Demographics
NPI:1013481134
Name:RICHE', BRENNAN J (DC)
Entity Type:Individual
Prefix:
First Name:BRENNAN
Middle Name:J
Last Name:RICHE'
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 1:805 SEQUOIA DR
Mailing Address - Street 2:
Mailing Address - City:ANNA
Mailing Address - State:TX
Mailing Address - Zip Code:75409-5073
Mailing Address - Country:US
Mailing Address - Phone:318-359-9853
Mailing Address - Fax:
Practice Address - Street 1:1450 HUGHES RD
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-7359
Practice Address - Country:US
Practice Address - Phone:318-359-9853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-11
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13999111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation