Provider Demographics
NPI:1891220414
Name:RIDGE CHIROPRACTIC
Entity Type:Organization
Organization Name:RIDGE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:GROSTIC
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-317-7583
Mailing Address - Street 1:39 LANCE ST
Mailing Address - Street 2:UNIT 6
Mailing Address - City:BLUE RIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30513-8024
Mailing Address - Country:US
Mailing Address - Phone:770-317-7583
Mailing Address - Fax:
Practice Address - Street 1:39 LANCE ST
Practice Address - Street 2:UNIT 6
Practice Address - City:BLUE RIDGE
Practice Address - State:GA
Practice Address - Zip Code:30513-8024
Practice Address - Country:US
Practice Address - Phone:770-317-7583
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-21
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO07653111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty