Provider Demographics
NPI:1306064951
Name:RIDKY, RICHARD JOSEPH (DC)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JOSEPH
Last Name:RIDKY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7026 CHARLESTON SHORES BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-7628
Mailing Address - Country:US
Mailing Address - Phone:561-432-6021
Mailing Address - Fax:
Practice Address - Street 1:7026 CHARLESTON SHORES BLVD
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-7628
Practice Address - Country:US
Practice Address - Phone:561-432-6021
Practice Address - Fax:561-432-6022
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7581111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55769OtherBCBS
FL55769XMedicare PIN
FL55769OtherBCBS
U75382Medicare UPIN
FL55769YMedicare PIN