Provider Demographics
NPI:1457683542
Name:RIDER CHIROPRACTIC CLINIC LLC
Entity Type:Organization
Organization Name:RIDER CHIROPRACTIC CLINIC LLC
Other - Org Name:RIDER WELLNESS & REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RIDER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:214-383-2641
Mailing Address - Street 1:820 S ALMA DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-3808
Mailing Address - Country:US
Mailing Address - Phone:214-383-2641
Mailing Address - Fax:
Practice Address - Street 1:105 ROCHDALE DR
Practice Address - Street 2:
Practice Address - City:ANNA
Practice Address - State:TX
Practice Address - Zip Code:75409-5174
Practice Address - Country:US
Practice Address - Phone:214-383-2641
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-01
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9091111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty