Provider Demographics
NPI:1699014431
Name:RIDGWAY, CALEB DANIEL (DC)
Entity Type:Individual
Prefix:DR
First Name:CALEB
Middle Name:DANIEL
Last Name:RIDGWAY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1105 N DUTTON AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-4682
Mailing Address - Country:US
Mailing Address - Phone:707-544-5338
Mailing Address - Fax:707-544-5193
Practice Address - Street 1:1105 N DUTTON AVE
Practice Address - Street 2:SUITE D
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-4682
Practice Address - Country:US
Practice Address - Phone:707-544-5338
Practice Address - Fax:707-544-5193
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-13
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32514111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor