Individual
RICHARD DARYL SHACKLEFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
409 10TH AVE, JASPER, AL 35501-3630
(205) 876-3177
Mailing address
4463 CUMBY RD, QUINTON, AL 35130-9196
(205) 876-3177
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
2388
AL
Other
Enumeration date
02/09/2023
Last updated
02/09/2023
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