Provider Demographics
NPI:1275409559
Name:RICHINS, SHANE (CPRC)
Entity type:Individual
Prefix:
First Name:SHANE
Middle Name:
Last Name:RICHINS
Suffix:
Gender:M
Credentials:CPRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 LAND BANK ST
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83402-1809
Mailing Address - Country:US
Mailing Address - Phone:208-522-6155
Mailing Address - Fax:208-286-4292
Practice Address - Street 1:1020 LAND BANK ST
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83402-1809
Practice Address - Country:US
Practice Address - Phone:208-522-6155
Practice Address - Fax:208-286-4292
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-14
Last Update Date:2025-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist