Provider Demographics
NPI:1447481874
Name:CRIDERSVILLE CHIROPRACTIC AND
Entity type:Organization
Organization Name:CRIDERSVILLE CHIROPRACTIC AND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:PATTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-863-9406
Mailing Address - Street 1:20523 MUDSOCK RD
Mailing Address - Street 2:
Mailing Address - City:WAPAKONETA
Mailing Address - State:OH
Mailing Address - Zip Code:45895-9024
Mailing Address - Country:US
Mailing Address - Phone:419-863-9406
Mailing Address - Fax:
Practice Address - Street 1:20523 MUDSOCK RD
Practice Address - Street 2:
Practice Address - City:WAPAKONETA
Practice Address - State:OH
Practice Address - Zip Code:45895-9024
Practice Address - Country:US
Practice Address - Phone:419-863-9406
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty