Provider Demographics
NPI:1740820992
Name:RICHARDSON, D'JUAN AMAUD (DC)
Entity type:Individual
Prefix:DR
First Name:D'JUAN
Middle Name:AMAUD
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 1:3000 WALNUT FOREST CT APT L
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-5675
Mailing Address - Country:US
Mailing Address - Phone:317-260-8188
Mailing Address - Fax:
Practice Address - Street 1:204 FAIR OAKS LN
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27127-3178
Practice Address - Country:US
Practice Address - Phone:336-248-8402
Practice Address - Fax:336-893-9511
Is Sole Proprietor?:No
Enumeration Date:2020-01-15
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.013505111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor