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General NPI Number Information
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NPI Number | 1376009472
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Entity Type | Organization
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Legal Business Name | RIDGEFIELD SPORTS MEDICINE, LLC
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Dates
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Enumeration Date | 02/13/2019
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Last Update Date | 05/02/2019
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Provider Practice Location Address
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Address Line | 159 DANBURY RD UNIT 105
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City | RIDGEFIELD
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State | CT
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Zip | 06877-3235
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Country | US
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Telephone | 203-403-6980
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Fax | 203-403-6172
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Provider Business Mailing Address
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Address Line | 159 DANBURY RD UNIT 105
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City | RIDGEFIELD
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State | CT
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Zip | 06877-3235
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Country | US
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Telephone | 203-403-6980
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Fax | 203-403-6172
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Authorized Official
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Title or Position | OWNER
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Name | DR. BETSY A PULICK
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Credential | DC
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Telephone | 914-760-3655
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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 |
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License Number State |
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