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General NPI Number Information
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NPI Number | 1780602672
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Entity Type | Organization
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Legal Business Name | MICHAEL G RIDGEWAY DC INC
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 777 FARMERS LANE
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City | SANTA ROSA
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State | CA
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Zip | 95405
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Country | US
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Telephone | 707-544-2400
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Fax | 707-544-5203
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Provider Business Mailing Address
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Address Line | 777 FARMERS LANE
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City | SANTA ROSA
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State | CA
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Zip | 95405
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Country | US
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Telephone | 707-544-2400
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Fax | 707-544-5203
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Authorized Official
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Title or Position | OWNER PRESIDENT
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Name | MR. MICHAEL G RIDGEWAY
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Credential | DC
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Telephone | 707-544-2400
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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 | 15617
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License Number State | CA
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