Provider Demographics
NPI:1760712715
Name:THE RIDER CENTER FOR CHIROPRACTIC AND WELLNESS, LLC
Entity Type:Organization
Organization Name:THE RIDER CENTER FOR CHIROPRACTIC AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:RIDER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-392-3353
Mailing Address - Street 1:12890 HILLCREST RD
Mailing Address - Street 2:STE 105
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-1504
Mailing Address - Country:US
Mailing Address - Phone:972-392-3353
Mailing Address - Fax:972-392-1601
Practice Address - Street 1:12890 HILLCREST RD
Practice Address - Street 2:STE 105
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-1504
Practice Address - Country:US
Practice Address - Phone:972-392-3353
Practice Address - Fax:972-392-1601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-13
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty