Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | T63479203 | VA |
NPI | 1003228487 |
---|---|
Provider Name | Bradley Richmond |
First Address | Midlothian, VA 23112-4031 |
Second Address | Midlothian, VA 23112-4031 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2014 |
Last Update Date | 30/09/2014 |