Provider Demographics
NPI:1013917582
Name:GILLESPIE, RICHARD L (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:L
Last Name:GILLESPIE
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 1:1520 OLD RANCH ROAD 12
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-2901
Mailing Address - Country:US
Mailing Address - Phone:512-396-2555
Mailing Address - Fax:
Practice Address - Street 1:1520 OLD RANCH ROAD 12
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-2901
Practice Address - Country:US
Practice Address - Phone:512-396-2555
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-27
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC2561111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX600925OtherBCBS PROVIDER NUMBER
TX600925Medicare ID - Type UnspecifiedMED PROVIDER NUMBER