Provider Demographics
NPI:1841667219
Name:DR. SHAY RIDGE LLC
Entity type:Organization
Organization Name:DR. SHAY RIDGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPERATOR CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAY
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:RIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:727-581-7429
Mailing Address - Street 1:405 SEMINOLE BLVD
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-3620
Mailing Address - Country:US
Mailing Address - Phone:727-581-7429
Mailing Address - Fax:727-581-3199
Practice Address - Street 1:405 SEMINOLE BLVD
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-3620
Practice Address - Country:US
Practice Address - Phone:727-581-7429
Practice Address - Fax:727-581-3199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-01
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10568111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHE005ZOtherMEDICARE PTAN