MEDICARE: DR. RICHARD JOSEPH RIDKY 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
1	111N00000X	Chiropractor	CH7581	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	55769	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1306064951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD JOSEPH RIDKY DC

Provider Business Mailing Address
First Line	:	7026 CHARLESTON SHORES BLVD
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-7628
Country	:	US
Telephone Number	:	561-432-6021
Fax Number	:

Provider Business Practice Location Address
First Line	:	7026 CHARLESTON SHORES BLVD
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-7628
Country	:	US
Telephone Number	:	561-432-6021
Fax Number	:	561-432-6022

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2007
Last Update Date	:	05/17/2011

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