Provider Demographics
NPI:1366108235
Name:RICH MOUNTAIN CHIROPRACTIC, PLLC
Entity type:Organization
Organization Name:RICH MOUNTAIN CHIROPRACTIC, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:GARRETT
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:479-385-9693
Mailing Address - Street 1:PO BOX 1224
Mailing Address - Street 2:
Mailing Address - City:MENA
Mailing Address - State:AR
Mailing Address - Zip Code:71953-1224
Mailing Address - Country:US
Mailing Address - Phone:479-365-9660
Mailing Address - Fax:844-222-7880
Practice Address - Street 1:601 HIGHWAY 71 N STE W
Practice Address - Street 2:
Practice Address - City:MENA
Practice Address - State:AR
Practice Address - Zip Code:71953-4394
Practice Address - Country:US
Practice Address - Phone:479-365-9660
Practice Address - Fax:844-222-7880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-15
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty