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General NPI Number Information
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NPI Number | 1851692891
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Entity Type | Organization
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Legal Business Name | DDMR PLLC
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Dates
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Enumeration Date | 11/08/2010
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Last Update Date | 11/08/2010
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Provider Practice Location Address
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Address Line | 1309 E SUNSET DR
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City | MONROE
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State | NC
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Zip | 28112-4324
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Country | US
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Telephone | 704-296-9090
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Fax |
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Provider Business Mailing Address
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Address Line | 420 UTILITY DR
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City | CLEMMONS
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State | NC
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Zip | 27012-8397
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Country | US
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Telephone | 336-766-5935
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Fax | 336-766-5365
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Authorized Official
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Title or Position | ORGANIZING MEMBER
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Name | DR. MICHAEL RICCOBONI
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Credential | D.C.
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Telephone | 336-766-5935
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 3062
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License Number State | NC
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