Provider Demographics
NPI:1780030502
Name:RIVERSIDE OSTEOPATHY LLC
Entity Type:Organization
Organization Name:RIVERSIDE OSTEOPATHY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GARRETT
Authorized Official - Middle Name:B
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:207-899-8130
Mailing Address - Street 1:PO BOX 292
Mailing Address - Street 2:
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-0292
Mailing Address - Country:US
Mailing Address - Phone:207-899-8130
Mailing Address - Fax:207-558-8258
Practice Address - Street 1:40 MAIN ST
Practice Address - Street 2:SUITE 131
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-5173
Practice Address - Country:US
Practice Address - Phone:207-899-8130
Practice Address - Fax:207-558-8258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-11
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Single Specialty