Provider Demographics
NPI:1295147502
Name:RICHARDS, CHANTZ (ND, LMP)
Entity type:Individual
Prefix:
First Name:CHANTZ
Middle Name:
Last Name:RICHARDS
Suffix:
Gender:M
Credentials:ND, LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 184TH ST SW STE R
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98037-4742
Mailing Address - Country:US
Mailing Address - Phone:425-224-7170
Mailing Address - Fax:425-775-1339
Practice Address - Street 1:3333 184TH ST SW STE R
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98037-4742
Practice Address - Country:US
Practice Address - Phone:425-224-7170
Practice Address - Fax:425-775-1339
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-21
Last Update Date:2019-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT60710043175F00000X
WAMA60428631225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist