Provider Demographics
NPI:1174368765
Name:RICHARDSON, KIERA N (DC)
Entity type:Individual
Prefix:DR
First Name:KIERA
Middle Name:N
Last Name:RICHARDSON
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 1:3964 DEQUATTRO DR UNIT 7305
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-7523
Mailing Address - Country:US
Mailing Address - Phone:919-522-7396
Mailing Address - Fax:
Practice Address - Street 1:555 WINDERLEY PL STE 105
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-7402
Practice Address - Country:US
Practice Address - Phone:407-401-8079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15027111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor