Provider Demographics
NPI:1912099656
Name:RICHEY, BRADLEY W (DC)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:W
Last Name:RICHEY
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 1:708 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:MO
Mailing Address - Zip Code:64085-1829
Mailing Address - Country:US
Mailing Address - Phone:816-776-5678
Mailing Address - Fax:816-776-3979
Practice Address - Street 1:708 E MAIN ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:MO
Practice Address - Zip Code:64085-1829
Practice Address - Country:US
Practice Address - Phone:816-776-5678
Practice Address - Fax:816-776-3979
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO006406111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MONO98979Medicare PIN