Provider Demographics
NPI:1386847838
Name:MICHAEL RIDGEWAY CHIROPRACTIC INC
Entity Type:Organization
Organization Name:MICHAEL RIDGEWAY CHIROPRACTIC INC
Other - Org Name:CHIROPRACTIC ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:RIDGEWAY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:707-544-2400
Mailing Address - Street 1:777 FARMERS LANE
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-6701
Mailing Address - Country:US
Mailing Address - Phone:707-544-2400
Mailing Address - Fax:
Practice Address - Street 1:777 FARMERS LANE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-6701
Practice Address - Country:US
Practice Address - Phone:707-544-2400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15617111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0156170Medicare ID - Type Unspecified