Provider Demographics
NPI:1447361464
Name:TALTON, RICHARD JAMES (DC)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JAMES
Last Name:TALTON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 OSCEOLA AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-4077
Mailing Address - Country:US
Mailing Address - Phone:904-246-9955
Mailing Address - Fax:904-246-9956
Practice Address - Street 1:422 OSCEOLA AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-4077
Practice Address - Country:US
Practice Address - Phone:904-246-9955
Practice Address - Fax:904-246-9956
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH2338111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59-1629962OtherTAX ID
FL59-1629962OtherTAX ID
FLT56345Medicare UPIN