Healthcare Provider Details

I. General information

NPI: 1164483772
Provider Name (Legal Business Name): EARL G. RITTER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 11/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1239 OLD BERWICK RD
BLOOMSBURG PA
17815-3023
US

IV. Provider business mailing address

1239 OLD BERWICK RD
BLOOMSBURG PA
17815-3023
US

V. Phone/Fax

Practice location:
  • Phone: 570-784-3932
  • Fax: 570-387-7968
Mailing address:
  • Phone: 570-784-3932
  • Fax: 570-387-7968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC001412L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number001412L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: