Provider Demographics
NPI:1780744862
Name:RICHWINE APPLIED KINESIOLOGY AND CHIROPRACTIC CLINIC
Entity type:Organization
Organization Name:RICHWINE APPLIED KINESIOLOGY AND CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ADRIENNE
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHWINE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:817-589-8890
Mailing Address - Street 1:4109 CAGLE DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:N RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180
Mailing Address - Country:US
Mailing Address - Phone:817-589-8890
Mailing Address - Fax:817-284-4412
Practice Address - Street 1:4109 CAGLE DR
Practice Address - Street 2:SUITE C
Practice Address - City:N RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180
Practice Address - Country:US
Practice Address - Phone:817-589-8890
Practice Address - Fax:817-284-4412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7333111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty