Provider Demographics
NPI:1104897651
Name:RICHARDS, JASON B (DC)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:B
Last Name:RICHARDS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2660 STATE ST
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06517-2226
Mailing Address - Country:US
Mailing Address - Phone:203-675-1644
Mailing Address - Fax:203-281-4466
Practice Address - Street 1:2660 STATE ST
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06517-2226
Practice Address - Country:US
Practice Address - Phone:203-675-1644
Practice Address - Fax:203-281-4466
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-31
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001570111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT11317593OtherCAQH
CT350001329Medicare ID - Type Unspecified
CT11317593OtherCAQH