Provider Demographics
NPI:1275500027
Name:DENNIS G RIDENOUR D.C. PC
Entity Type:Organization
Organization Name:DENNIS G RIDENOUR D.C. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:G
Authorized Official - Last Name:RIDENOUR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:814-696-3531
Mailing Address - Street 1:1705 N JUNIATA ST
Mailing Address - Street 2:
Mailing Address - City:HOLLIDAYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16648
Mailing Address - Country:US
Mailing Address - Phone:814-696-3531
Mailing Address - Fax:814-696-3534
Practice Address - Street 1:1705 N JUNIATA ST.
Practice Address - Street 2:
Practice Address - City:HOLLIDAYSBURG
Practice Address - State:PA
Practice Address - Zip Code:16648
Practice Address - Country:US
Practice Address - Phone:814-696-3531
Practice Address - Fax:814-696-3534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-01
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001316L111N00000X
CO2858111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001489379OtherHIGHMARK BLUE CROSS BLUE
PA00645328Medicaid
PA001489379OtherHIGHMARK BLUE CROSS BLUE
PA000645328002Medicare ID - Type Unspecified
115694Medicare ID - Type Unspecified