Provider Demographics
NPI:1154418986
Name:RICHARDSON, DANA S (DC)
Entity type:Individual
Prefix:DR
First Name:DANA
Middle Name:S
Last Name:RICHARDSON
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 1:507 MERCHANT ST
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95688-4511
Mailing Address - Country:US
Mailing Address - Phone:707-449-9217
Mailing Address - Fax:707-449-9237
Practice Address - Street 1:507 MERCHANT ST
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688-4511
Practice Address - Country:US
Practice Address - Phone:707-449-9217
Practice Address - Fax:707-449-9237
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18607111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ03350ZOtherBLUE SHIELD
CADC18607Medicare UPIN
CADC0186070Medicare ID - Type Unspecified
CAZZZ03350ZOtherBLUE SHIELD