1275500027 NPI number — DENNIS G RIDENOUR D.C. PC

Table of content: (NPI 1275500027)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275500027 NPI number — DENNIS G RIDENOUR D.C. PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DENNIS G RIDENOUR D.C. PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275500027
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/22/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1705 N JUNIATA ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOLLIDAYSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16648
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-696-3531
Provider Business Mailing Address Fax Number:
814-696-3534

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1705 N JUNIATA ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOLLIDAYSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16648
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-696-3531
Provider Business Practice Location Address Fax Number:
814-696-3534
Provider Enumeration Date:
03/01/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RIDENOUR
Authorized Official First Name:
DENNIS
Authorized Official Middle Name:
G
Authorized Official Title or Position:
OWNER/CHIROPRACTOR
Authorized Official Telephone Number:
814-696-3531

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DC001316L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 111N00000X , with the licence number: 2858 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 001489379 . This is a "HIGHMARK BLUE CROSS BLUE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 00645328 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".