Provider Demographics
NPI:1801113105
Name:RICHARDS, TODD (DC)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:
Last Name:RICHARDS
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 1:225 HORNBY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-7329
Mailing Address - Country:US
Mailing Address - Phone:208-597-7177
Mailing Address - Fax:208-597-7503
Practice Address - Street 1:513 N 4TH AVE
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-1585
Practice Address - Country:US
Practice Address - Phone:208-597-7177
Practice Address - Fax:208-597-7503
Is Sole Proprietor?:No
Enumeration Date:2010-04-26
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1532111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID46-0823640OtherEIN