Provider Demographics
NPI:1124348271
Name:RIDER CHIROPRACTIC PC
Entity type:Organization
Organization Name:RIDER CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RACHELLE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:RIDER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:402-990-0648
Mailing Address - Street 1:200 NORTH STREET
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:NE
Mailing Address - Zip Code:68366-2502
Mailing Address - Country:US
Mailing Address - Phone:402-990-0648
Mailing Address - Fax:
Practice Address - Street 1:13220 CALLUM DR
Practice Address - Street 2:SUITE 2
Practice Address - City:WAVERLY
Practice Address - State:NE
Practice Address - Zip Code:68462-2561
Practice Address - Country:US
Practice Address - Phone:402-990-0648
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-10
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1615111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1615OtherCHIROPRACTIC LICENSE