Provider Demographics
NPI:1447303813
Name:RICHARD, AMY MICHELLE (DC)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:MICHELLE
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 1:4405 ROSA AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63116-2216
Mailing Address - Country:US
Mailing Address - Phone:314-352-4205
Mailing Address - Fax:
Practice Address - Street 1:4227 WATSON RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63109-1211
Practice Address - Country:US
Practice Address - Phone:314-647-3399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006017835111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor