Healthcare Provider Details

I. General information

NPI: 1871638569
Provider Name (Legal Business Name): RIDGE ROAD FAMILY CHIROPRACTIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4674 RIDGE RD
BROOKLYN OH
44144-3317
US

IV. Provider business mailing address

4674 RIDGE RD
BROOKLYN OH
44144-3317
US

V. Phone/Fax

Practice location:
  • Phone: 216-749-7888
  • Fax: 216-749-6660
Mailing address:
  • Phone: 216-749-7888
  • Fax: 216-749-6660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: LINDA L GROVES
Title or Position: BILLING MANAGER
Credential: CPC,CPCH,MBP,CMA
Phone: 440-352-6132