Provider Demographics
NPI:1720256308
Name:RICHARDS, KENNETH EDWARD (DC, DPT)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:EDWARD
Last Name:RICHARDS
Suffix:
Gender:M
Credentials:DC, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 FIDDLERS RUN BLVD
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655
Mailing Address - Country:US
Mailing Address - Phone:828-437-1786
Mailing Address - Fax:828-438-4032
Practice Address - Street 1:139 FIDDLERS RUN BLVD
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655
Practice Address - Country:US
Practice Address - Phone:828-437-1786
Practice Address - Fax:828-438-4032
Is Sole Proprietor?:No
Enumeration Date:2008-02-15
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2451111NS0005X
NCP15053225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0833COtherBC/BS
NC2451635BMedicare PIN