Provider Demographics
NPI:1164483772
Name:RITTER, EARL G (DC)
Entity Type:Individual
Prefix:
First Name:EARL
Middle Name:G
Last Name:RITTER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1239 OLD BERWICK RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17815-3023
Mailing Address - Country:US
Mailing Address - Phone:570-784-3932
Mailing Address - Fax:570-387-7968
Practice Address - Street 1:1239 OLD BERWICK RD
Practice Address - Street 2:
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815-3023
Practice Address - Country:US
Practice Address - Phone:570-784-3932
Practice Address - Fax:570-387-7968
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001412L111N00000X
PA001412L111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01577901OtherCAPITAL BLUE CROSS
PA115677OtherHIGHMARK BLUE SHIELD
PA1001294055Medicaid
PA115677Medicare ID - Type UnspecifiedCHIROPRACTOR