Provider Demographics
NPI:1801914809
Name:DUCKWORTH, RICHARD JORDAN (DC)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JORDAN
Last Name:DUCKWORTH
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 1:11790 BARON CAMERON
Mailing Address - Street 2:SUITE J
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-5872
Mailing Address - Country:US
Mailing Address - Phone:703-689-3500
Mailing Address - Fax:703-689-2227
Practice Address - Street 1:11790 BARON CAMERON AVE
Practice Address - Street 2:SUITE J
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5872
Practice Address - Country:US
Practice Address - Phone:703-689-3500
Practice Address - Fax:703-689-2227
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10496111N00000X
VA0104556577111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor