Provider Demographics
NPI:1033215843
Name:RITTER, DAVE
Entity Type:Individual
Prefix:MR
First Name:DAVE
Middle Name:
Last Name:RITTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MT ZION
Mailing Address - State:IL
Mailing Address - Zip Code:62549-1543
Mailing Address - Country:US
Mailing Address - Phone:217-423-4466
Mailing Address - Fax:217-423-9461
Practice Address - Street 1:144 E LEAFLAND AVE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62521-1020
Practice Address - Country:US
Practice Address - Phone:217-423-4466
Practice Address - Fax:217-423-9461
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other