Provider Demographics
NPI:1083171094
Name:RICHMOND, AMY (DC, DAT, LAT, ATC)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:
Last Name:RICHMOND
Suffix:
Gender:F
Credentials:DC, DAT, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7215 E SILVERSTONE DR APT 3106
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-4972
Mailing Address - Country:US
Mailing Address - Phone:609-970-1382
Mailing Address - Fax:
Practice Address - Street 1:4722 E RAY RD STE 5
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-6226
Practice Address - Country:US
Practice Address - Phone:480-460-1399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-26
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZATR-1001562255A2300X
PART0055832255A2300X
AZ9409111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer