Provider Demographics
NPI:1871839050
Name:RIVER ROAD WELLNESS LLC
Entity Type:Organization
Organization Name:RIVER ROAD WELLNESS LLC
Other - Org Name:RIVERSIDE CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:B
Authorized Official - Last Name:BECK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:207-703-2641
Mailing Address - Street 1:583 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:ELIOT
Mailing Address - State:ME
Mailing Address - Zip Code:03903-1076
Mailing Address - Country:US
Mailing Address - Phone:207-475-4622
Mailing Address - Fax:207-686-3053
Practice Address - Street 1:583 RIVER RD
Practice Address - Street 2:
Practice Address - City:ELIOT
Practice Address - State:ME
Practice Address - Zip Code:03903-1076
Practice Address - Country:US
Practice Address - Phone:207-703-2641
Practice Address - Fax:207-703-2642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-17
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty