Provider Demographics
NPI:1215331475
Name:RICHARDSON, CHARLES EDWARD III (DC)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:EDWARD
Last Name:RICHARDSON
Suffix:III
Gender:M
Credentials:DC
Other - Prefix:
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Mailing Address - Street 1:6738 HINDS AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-1611
Mailing Address - Country:US
Mailing Address - Phone:818-967-9874
Mailing Address - Fax:818-352-8116
Practice Address - Street 1:7709 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:TUJUNGA
Practice Address - State:CA
Practice Address - Zip Code:91042-2120
Practice Address - Country:US
Practice Address - Phone:818-804-0525
Practice Address - Fax:818-352-8116
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-17
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CADC33073111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor