Provider Demographics
NPI:1023615176
Name:RICHENS, DAVID (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:RICHENS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:DAVID
Other - Middle Name:
Other - Last Name:RICHENS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:5640 WASATCH DR STE E
Mailing Address - Street 2:
Mailing Address - City:SOUTH OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-4993
Mailing Address - Country:US
Mailing Address - Phone:801-388-3640
Mailing Address - Fax:
Practice Address - Street 1:5640 WASATCH DR STE E
Practice Address - Street 2:
Practice Address - City:SOUTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-4993
Practice Address - Country:US
Practice Address - Phone:801-388-3640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-01
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT119014831202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor