Provider Demographics
NPI:1053749531
Name:MAPLE RIDGE CHIROPRACTIC & MASSAGE
Entity type:Organization
Organization Name:MAPLE RIDGE CHIROPRACTIC & MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:REED
Authorized Official - Middle Name:R
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-655-3989
Mailing Address - Street 1:655 E 400 S STE D
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84663-2039
Mailing Address - Country:US
Mailing Address - Phone:801-655-3989
Mailing Address - Fax:
Practice Address - Street 1:655 E 400 S STE D
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:UT
Practice Address - Zip Code:84663-2039
Practice Address - Country:US
Practice Address - Phone:801-655-3989
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-21
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8817809-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty