Provider Demographics
NPI:1740297597
Name:RICHARDSON, TERRYL J (DC)
Entity type:Individual
Prefix:
First Name:TERRYL
Middle Name:J
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 146
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371-0015
Mailing Address - Country:US
Mailing Address - Phone:253-537-8181
Mailing Address - Fax:253-537-8181
Practice Address - Street 1:5216 72ND ST E
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98443-2722
Practice Address - Country:US
Practice Address - Phone:253-537-8181
Practice Address - Fax:253-537-8181
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001528111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA17087OtherDEPT. OF LABOR AND INDUST
WA606549100OtherDEPT OF LABOR - OWCP
WA350000483OtherRAILROAD MEDICARE
WAR13361OtherPRIVATE INSURANCE
WA17087OtherDEPT. OF LABOR AND INDUST
WAR13361OtherPRIVATE INSURANCE