1124477443 NPI number — DR. HEATHER RICHMOND LA.C DAOM

Table of content: DR. HEATHER RICHMOND LA.C DAOM (NPI 1124477443)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124477443 NPI number — DR. HEATHER RICHMOND LA.C DAOM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RICHMOND
Provider First Name:
HEATHER
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
LA.C DAOM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1124477443
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2112
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOULDER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80306-2112
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-444-4790
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
908 MAIN ST STE B104
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80027-1867
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-444-4790
Provider Business Practice Location Address Fax Number:
720-598-6121
Provider Enumeration Date:
06/07/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  0002080 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0431938 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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