Provider Demographics
NPI:1871515395
Name:RICHARDSON, JENNISE (DC)
Entity type:Individual
Prefix:DR
First Name:JENNISE
Middle Name:
Last Name:RICHARDSON
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 1:5010 BROWER CREST DR
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504-1748
Mailing Address - Country:US
Mailing Address - Phone:281-451-3111
Mailing Address - Fax:281-991-7870
Practice Address - Street 1:17080 HIGHWAY 3
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4129
Practice Address - Country:US
Practice Address - Phone:281-557-5525
Practice Address - Fax:281-557-5517
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10076111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor