Provider Demographics
NPI:1386949303
Name:RIDGE LINE CHIROPRACTIC LLC
Entity type:Organization
Organization Name:RIDGE LINE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JONATHON
Authorized Official - Middle Name:
Authorized Official - Last Name:MAINIERI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-790-1455
Mailing Address - Street 1:9894 ROSEMONT AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:LONETREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-4103
Mailing Address - Country:US
Mailing Address - Phone:303-790-1455
Mailing Address - Fax:
Practice Address - Street 1:9894 ROSEMONT AVE STE 103
Practice Address - Street 2:
Practice Address - City:LONETREE
Practice Address - State:CO
Practice Address - Zip Code:80124-4103
Practice Address - Country:US
Practice Address - Phone:303-790-1455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-23
Last Update Date:2011-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR-6422111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty