Provider Demographics
NPI:1770649774
Name:RIDGWAY, DUSTIN E (DC)
Entity Type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:E
Last Name:RIDGWAY
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 1:3473 MAIN AVE STE 15
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-4040
Mailing Address - Country:US
Mailing Address - Phone:970-247-5519
Mailing Address - Fax:970-382-8457
Practice Address - Street 1:3473 MAIN AVE STE 15
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-4040
Practice Address - Country:US
Practice Address - Phone:970-247-5519
Practice Address - Fax:970-382-8457
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR-6720111N00000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK900522079Medicare ID - Type Unspecified