Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 042617164 | IL |
NPI | 1245322940 |
---|---|
Provider Name | Dr. Hal Richart |
First Address | Plainfield, IL 60586-7033 |
Second Address | Plainfield, IL 60586-7033 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2006 |
Last Update Date | 01/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T38604 | (02) |