Provider Demographics
NPI:1144312810
Name:RICHMOND, SCOTT OLLIN (DC)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:OLLIN
Last Name:RICHMOND
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 1:2753 86TH ST
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-4336
Mailing Address - Country:US
Mailing Address - Phone:515-278-5940
Mailing Address - Fax:515-278-1517
Practice Address - Street 1:2753 86TH ST
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-4336
Practice Address - Country:US
Practice Address - Phone:515-278-5940
Practice Address - Fax:515-278-1517
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06832111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor