Provider Demographics
NPI:1326030115
Name:PIDDE, RIDGE M (DC)
Entity type:Individual
Prefix:
First Name:RIDGE
Middle Name:M
Last Name:PIDDE
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 1:2004 FORD PKWY
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55116-1931
Mailing Address - Country:US
Mailing Address - Phone:651-265-0000
Mailing Address - Fax:651-265-0001
Practice Address - Street 1:2004 FORD PKWY
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55116-1931
Practice Address - Country:US
Practice Address - Phone:651-265-0000
Practice Address - Fax:651-265-0001
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3805111N00000X
MN4136111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38935900Medicaid
WIU88961Medicare UPIN
WI38935900Medicaid