Provider Demographics
NPI:1609856558
Name:MADSEN, RICHARD K
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:K
Last Name:MADSEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:291 E 4500 S
Mailing Address - Street 2:STE C
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107
Mailing Address - Country:US
Mailing Address - Phone:801-264-1235
Mailing Address - Fax:801-264-1805
Practice Address - Street 1:291 E 4500 S
Practice Address - Street 2:STE C
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107
Practice Address - Country:US
Practice Address - Phone:801-264-1235
Practice Address - Fax:801-264-1805
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTUT871754281202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U82603Medicare UPIN