Provider Demographics
NPI:1023173663
Name:RICHARDSON, J MACANDREW (DC)
Entity type:Individual
Prefix:DR
First Name:J MACANDREW
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:ANDREU J MACANDREW
Other - Middle Name:
Other - Last Name:RICHARDSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:2450 NE 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33305-1304
Mailing Address - Country:US
Mailing Address - Phone:954-537-8898
Mailing Address - Fax:954-537-8898
Practice Address - Street 1:2450 NE 13TH AVE
Practice Address - Street 2:
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33305-1304
Practice Address - Country:US
Practice Address - Phone:954-537-8898
Practice Address - Fax:954-537-8898
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 9030111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCH 9030OtherLICENSE