Provider Demographics
NPI:1427174754
Name:RIDENOUR, DENNIS G (DC)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:G
Last Name:RIDENOUR
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 1:1705 N JUNIATA ST
Mailing Address - Street 2:
Mailing Address - City:HOLLIDAYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16648
Mailing Address - Country:US
Mailing Address - Phone:814-696-3531
Mailing Address - Fax:814-696-3534
Practice Address - Street 1:1705 N JUNIATA ST
Practice Address - Street 2:
Practice Address - City:HOLLIDAYSBURG
Practice Address - State:PA
Practice Address - Zip Code:16648
Practice Address - Country:US
Practice Address - Phone:814-696-3531
Practice Address - Fax:814-696-3534
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001316L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000645328Medicaid
PA00645328Medicaid
PA00645328Medicaid
PA000645328Medicaid