Provider Demographics
NPI:1154511533
Name:RIDGLEY, MIGUEL (D C)
Entity Type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:
Last Name:RIDGLEY
Suffix:
Gender:F
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2850 MANHATTAN BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058-2911
Mailing Address - Country:US
Mailing Address - Phone:504-362-3000
Mailing Address - Fax:504-362-3059
Practice Address - Street 1:2850 MANHATTAN BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058-2911
Practice Address - Country:US
Practice Address - Phone:504-362-3000
Practice Address - Fax:504-362-3059
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-31
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1383111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor