Provider Demographics
NPI:1033712591
Name:RICHARD, KELLI-JO (DC)
Entity type:Individual
Prefix:
First Name:KELLI-JO
Middle Name:
Last Name:RICHARD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1913 W CONGRESS ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-4433
Mailing Address - Country:US
Mailing Address - Phone:337-240-6003
Mailing Address - Fax:
Practice Address - Street 1:1913 W CONGRESS ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-4433
Practice Address - Country:US
Practice Address - Phone:337-240-6003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1954111NP0017X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1954OtherLA CHIROPRACTIC LICENSE NUMBER