Provider Demographics
NPI:1245783778
Name:RICHARDS CHIROPRACTIC LLC
Entity type:Organization
Organization Name:RICHARDS CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-788-5940
Mailing Address - Street 1:16645 W GREENFIELD AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-1424
Mailing Address - Country:US
Mailing Address - Phone:262-788-5940
Mailing Address - Fax:262-788-5986
Practice Address - Street 1:16645 W GREENFIELD AVE
Practice Address - Street 2:SUITE D
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-1424
Practice Address - Country:US
Practice Address - Phone:262-788-5940
Practice Address - Fax:262-788-5986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-02
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5198-12261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care