1649583550 NPI number — ALVIN J. RICHARD, PC

Table of content: (NPI 1649583550)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649583550 NPI number — ALVIN J. RICHARD, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALVIN J. RICHARD, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CHIROPRACTIC FIRST
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649583550
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/31/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 4096
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LIBERTY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77575-2296
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
936-334-0004
Provider Business Mailing Address Fax Number:
936-334-0010

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2720 N. MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LIBERTY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77575-3909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
936-334-0004
Provider Business Practice Location Address Fax Number:
936-334-0010
Provider Enumeration Date:
07/20/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RICHARD
Authorized Official First Name:
ALVIN
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
936-334-0004

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  9198 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0059WY . This is a "BC/BS TYPE 2 (GROUP)" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8CZ242 . This is a "BC/BS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".