Provider Demographics
NPI:1538374459
Name:RICHARDS, MARK E (CHIROPRACTOR)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:E
Last Name:RICHARDS
Suffix:
Gender:M
Credentials:CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1907 N ANDREWS AVE
Mailing Address - Street 2:
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33311-3914
Mailing Address - Country:US
Mailing Address - Phone:954-567-1924
Mailing Address - Fax:954-567-1925
Practice Address - Street 1:1907 N ANDREWS AVE
Practice Address - Street 2:
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33311-3914
Practice Address - Country:US
Practice Address - Phone:954-567-1924
Practice Address - Fax:954-567-1925
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8257111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor