Healthcare Provider Details

I. General information

NPI: 1124348271
Provider Name (Legal Business Name): RIDER CHIROPRACTIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2010
Last Update Date: 07/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13220 CALLUM DR SUITE 2
WAVERLY NE
68462-2561
US

IV. Provider business mailing address

200 NORTH STREET
GREENWOOD NE
68366-2502
US

V. Phone/Fax

Practice location:
  • Phone: 402-990-0648
  • Fax:
Mailing address:
  • Phone: 402-990-0648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1615
License Number StateNE

VIII. Authorized Official

Name: DR. RACHELLE LEE RIDER
Title or Position: PRESIDENT
Credential: D.C.
Phone: 402-990-0648