Healthcare Provider Details

I. General information

NPI: 1487624847
Provider Name (Legal Business Name): MATTHEW RYDER DORCHESTER DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 02/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18325 N ALLIED WAY SUITE 105
PHOENIX AZ
85054-3105
US

IV. Provider business mailing address

8894 E RUSTY SPUR PL
SCOTTSDALE AZ
85255-9166
US

V. Phone/Fax

Practice location:
  • Phone: 480-991-3399
  • Fax: 480-905-0815
Mailing address:
  • Phone: 480-991-3399
  • Fax: 480-905-0815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number4478
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: