Basic Information
| Provider Information | |||||||||
| NPI: | 1114219557 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | RIDGEWOOD CHIROPRACTIC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 415 | ||||||||
| Address2: | |||||||||
| City: | HAWTHORNE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 075070415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9738656364 | ||||||||
| FaxNumber: | 9735957553 | ||||||||
| Practice Location | |||||||||
| Address1: | 172 FRANKLIN AVE | ||||||||
| Address2: | SUITE 4A | ||||||||
| City: | RIDGEWOOD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 074503250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2018575770 | ||||||||
| FaxNumber: | 2018575771 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2011 | ||||||||
| LastUpdateDate: | 07/07/2011 | ||||||||
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| AuthorizedOfficialLastName: | MARGOLIN | ||||||||
| AuthorizedOfficialFirstName: | GUY | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9738656364 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | 38MC00635300 | NJ | Y | 193400000X SINGLE SPECIALTY GROUP | Chiropractic Providers | Chiropractor |
No ID Information.