Provider Demographics
NPI:1962537837
Name:RICHARD, SHARI LEE (DC)
Entity type:Individual
Prefix:DR
First Name:SHARI
Middle Name:LEE
Last Name:RICHARD
Suffix:
Gender:F
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:PO BOX 1206
Mailing Address - Street 2:
Mailing Address - City:SOUTH WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06074-7206
Mailing Address - Country:US
Mailing Address - Phone:860-290-1598
Mailing Address - Fax:
Practice Address - Street 1:352R MIDDLE TPKE W
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-3824
Practice Address - Country:US
Practice Address - Phone:860-290-1598
Practice Address - Fax:860-643-1603
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001239111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTU67434Medicare UPIN