Provider Demographics
NPI:1023314986
Name:RICHARDSON, MATTHEW L (DC)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:L
Last Name:RICHARDSON
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 1:4400 LINGLESTOWN RD 108
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17112-8534
Mailing Address - Country:US
Mailing Address - Phone:717-500-1203
Mailing Address - Fax:717-406-1567
Practice Address - Street 1:4400 LINGLESTOWN RD 108
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-8534
Practice Address - Country:US
Practice Address - Phone:717-500-1203
Practice Address - Fax:717-406-1567
Is Sole Proprietor?:No
Enumeration Date:2011-02-09
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA010794111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor