Provider Demographics
NPI:1073653093
Name:RICCIARDONE, MICHAEL JR (DC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:RICCIARDONE
Suffix:JR
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 1:92 MANHATTAN AVE
Mailing Address - Street 2:
Mailing Address - City:WALDWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:07463-2229
Mailing Address - Country:US
Mailing Address - Phone:201-225-1665
Mailing Address - Fax:201-967-0079
Practice Address - Street 1:820 RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:ORADELL
Practice Address - State:NJ
Practice Address - Zip Code:07649-2040
Practice Address - Country:US
Practice Address - Phone:201-225-1665
Practice Address - Fax:201-967-0079
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00297800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor