Provider Demographics
NPI:1962110940
Name:RIDGE CHIROPRACTIC AND REHAB LLC
Entity type:Organization
Organization Name:RIDGE CHIROPRACTIC AND REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:215-257-5757
Mailing Address - Street 1:612 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SELLERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18960-1338
Mailing Address - Country:US
Mailing Address - Phone:215-257-5757
Mailing Address - Fax:215-257-1752
Practice Address - Street 1:612 RIDGE RD
Practice Address - Street 2:
Practice Address - City:SELLERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18960-1338
Practice Address - Country:US
Practice Address - Phone:215-257-5757
Practice Address - Fax:215-257-1752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-09
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty