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General NPI Number Information
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NPI Number | 1114219557
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Entity Type | Organization
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Legal Business Name | RIDGEWOOD CHIROPRACTIC
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Dates
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Enumeration Date | 05/04/2011
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Last Update Date | 07/07/2011
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Provider Practice Location Address
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Address Line | 172 FRANKLIN AVE SUITE 4A
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City | RIDGEWOOD
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State | NJ
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Zip | 07450-3250
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Country | US
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Telephone | 201-857-5770
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Fax | 201-857-5771
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Provider Business Mailing Address
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Address Line | PO BOX 415
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City | HAWTHORNE
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State | NJ
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Zip | 07507-0415
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Country | US
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Telephone | 973-865-6364
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Fax | 973-595-7553
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Authorized Official
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Title or Position | OWNER
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Name | DR. GUY E MARGOLIN
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Credential | DC
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Telephone | 973-865-6364
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 38MC00635300
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License Number State | NJ
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