Provider Demographics
NPI:1316972474
Name:RICHESON, FLOYD KEITH (DC)
Entity type:Individual
Prefix:
First Name:FLOYD
Middle Name:KEITH
Last Name:RICHESON
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 1:410 N MAIN ST
Mailing Address - Street 2:SUITE 11
Mailing Address - City:CHIEFLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32626-0866
Mailing Address - Country:US
Mailing Address - Phone:352-490-7077
Mailing Address - Fax:352-490-7177
Practice Address - Street 1:410 N MAIN ST
Practice Address - Street 2:SUITE 11
Practice Address - City:CHIEFLAND
Practice Address - State:FL
Practice Address - Zip Code:32626-0866
Practice Address - Country:US
Practice Address - Phone:352-490-7077
Practice Address - Fax:352-490-7177
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0002662111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL89973YMedicaid
FL89973YMedicaid