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NPI Code Detail

MEDICARE: RIDGE M PIDDE DC

MEDICARE: RIDGE M PIDDE 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
1111N00000XChiropractor3805WI
2111N00000XChiropractor4136MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1326030115
Entity Type Code : Individual
Provider Name (Legal Business Name) : RIDGE M PIDDE DC
Provider Business Mailing Address
First Line : 2004 FORD PKWY
Second Line :
City : SAINT PAUL
State : MN
Zip : 55116-1931
Country : US
Telephone Number : 651-265-0000
Fax Number : 651-265-0001
Provider Business Practice Location Address
First Line : 2004 FORD PKWY
Second Line :
City : SAINT PAUL
State : MN
Zip : 55116-1931
Country : US
Telephone Number : 651-265-0000
Fax Number : 651-265-0001
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/17/2005
Last Update Date : 09/15/2021

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Directions to “ RIDGE M PIDDE DC” Practice Location

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