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NPI Code Detail

MEDICARE: DR. DARYL LEE RIDGEWAY DC

MEDICARE: DR. DARYL LEE RIDGEWAY DC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111N00000XChiropractor006613MO

General Provider Information

NPI Number : 1043371610
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DARYL LEE RIDGEWAY DC
Provider Business Mailing Address
First Line : 1023 MAIN PLAZA DR
Second Line :
City : WENTZVILLE
State : MO
Zip : 63385-1170
Country : US
Telephone Number : 636-639-8944
Fax Number :
Provider Business Practice Location Address
First Line : 1023 MAIN PLAZA DR
Second Line :
City : WENTZVILLE
State : MO
Zip : 63385-1170
Country : US
Telephone Number : 636-639-8944
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/13/2006
Last Update Date : 07/02/2008

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Directions to “ DR. DARYL LEE RIDGEWAY DC” Practice Location

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