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Individual
MR. RICHARD KIM ETHEREDGE
Active
Individual
MR. RICHARD KIM ETHEREDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CH5758
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22261
BC
FL
05
—
380121700
—
FL
Enumeration date
08/31/2006
Last updated
02/16/2012
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