Provider Demographics
NPI:1811977739
Name:RICHERSON, JAMES KEVIN (DC)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:KEVIN
Last Name:RICHERSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:KEVIN
Other - Middle Name:
Other - Last Name:RICHERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:202 NANCY COX DR
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42718-8842
Mailing Address - Country:US
Mailing Address - Phone:270-469-9308
Mailing Address - Fax:270-469-9308
Practice Address - Street 1:202 NANCY COX DR
Practice Address - Street 2:
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718-8842
Practice Address - Country:US
Practice Address - Phone:270-469-9308
Practice Address - Fax:270-469-9308
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4920111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1223630OtherCHA
KY000000371486OtherANTHEM BC/BS
KY381065OtherBLUEGRASS FAMILY HEALTH
KY1223630OtherCHA
KY000000371486OtherANTHEM BC/BS