Provider Demographics
NPI:1912902974
Name:RICCIARDI, SCOTT ALLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:ALLEN
Last Name:RICCIARDI
Suffix:
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 1:16494 ST. CLAIR AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:EAST LIVERPOOL
Mailing Address - State:OH
Mailing Address - Zip Code:43920-9465
Mailing Address - Country:US
Mailing Address - Phone:330-386-6222
Mailing Address - Fax:330-386-3378
Practice Address - Street 1:16494 ST. CLAIR AVE
Practice Address - Street 2:SUITE C
Practice Address - City:EAST LIVERPOOL
Practice Address - State:OH
Practice Address - Zip Code:43920-9465
Practice Address - Country:US
Practice Address - Phone:330-386-6222
Practice Address - Fax:330-386-3378
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1929111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0131937000Medicaid
000000137719OtherANTHEM BC/BS PROVIDER ID
OH0928563Medicaid
OH9044330Medicaid
622722OtherHIGHMARK BCBS
OHU46068Medicare UPIN
WV0131937000Medicaid
000000137719OtherANTHEM BC/BS PROVIDER ID