Provider Demographics
NPI:1508186685
Name:RIDGEWAY, LAUREN PEARSON (DC)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:PEARSON
Last Name:RIDGEWAY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3796 CHAPEL HILL RD
Mailing Address - Street 2:
Mailing Address - City:CRAWFORD
Mailing Address - State:TN
Mailing Address - Zip Code:38554-3639
Mailing Address - Country:US
Mailing Address - Phone:931-239-1993
Mailing Address - Fax:
Practice Address - Street 1:111 MARBURY XING
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-2215
Practice Address - Country:US
Practice Address - Phone:931-455-0408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-10
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2407111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor