Provider Demographics
NPI:1174710677
Name:RICHERT CHIROPRACTIC INC
Entity type:Organization
Organization Name:RICHERT CHIROPRACTIC INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:A
Authorized Official - Last Name:RICHERT
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:260-749-2225
Mailing Address - Street 1:610 PROFESSIONAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:IN
Mailing Address - Zip Code:46774-1995
Mailing Address - Country:US
Mailing Address - Phone:260-749-2225
Mailing Address - Fax:
Practice Address - Street 1:610 PROFESSIONAL PARK DR
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:IN
Practice Address - Zip Code:46774-1995
Practice Address - Country:US
Practice Address - Phone:260-749-2225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-27
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ININ08001598A171100000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1811994684OtherNPPES
INU55107Medicare UPIN