Provider Demographics
NPI:1417025404
Name:RIDER, CHAD MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:MICHAEL
Last Name:RIDER
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 1:2338 CUESTA LN
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-3810
Mailing Address - Country:US
Mailing Address - Phone:214-383-2641
Mailing Address - Fax:
Practice Address - Street 1:820 S ALMA DR
Practice Address - Street 2:100
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-3808
Practice Address - Country:US
Practice Address - Phone:214-383-2641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9091111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX609640Medicare ID - Type Unspecified