Provider Demographics
NPI:1316085921
Name:CONANT, RICHARD M (LAC)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:M
Last Name:CONANT
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2439 SW 306TH PL
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98023-2339
Mailing Address - Country:US
Mailing Address - Phone:253-835-0960
Mailing Address - Fax:
Practice Address - Street 1:1420 MERIDIAN E STE 2
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:WA
Practice Address - Zip Code:98354-9387
Practice Address - Country:US
Practice Address - Phone:253-835-0960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00000250171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist