Provider Demographics
NPI:1316247034
Name:RICHARD, MARK SEBASTIAN (DC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:SEBASTIAN
Last Name:RICHARD
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 1:1796 W CAUSEWAY APPROACH
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-2955
Mailing Address - Country:US
Mailing Address - Phone:985-626-1671
Mailing Address - Fax:985-624-4984
Practice Address - Street 1:1796 W CAUSEWAY APPROACH
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-2955
Practice Address - Country:US
Practice Address - Phone:985-626-1671
Practice Address - Fax:985-624-4984
Is Sole Proprietor?:No
Enumeration Date:2010-10-27
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1584111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor