Provider Demographics
NPI:1114219557
Name:RIDGEWOOD CHIROPRACTIC
Entity Type:Organization
Organization Name:RIDGEWOOD CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GUY
Authorized Official - Middle Name:E
Authorized Official - Last Name:MARGOLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-865-6364
Mailing Address - Street 1:PO BOX 415
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07507-0415
Mailing Address - Country:US
Mailing Address - Phone:973-865-6364
Mailing Address - Fax:973-595-7553
Practice Address - Street 1:172 FRANKLIN AVE
Practice Address - Street 2:SUITE 4A
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3250
Practice Address - Country:US
Practice Address - Phone:201-857-5770
Practice Address - Fax:201-857-5771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-04
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00635300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty