Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC007648L | PA |
NPI | 1003990128 |
---|---|
Provider Name | Dr. Steven David Ries |
First Address | Lancaster, PA 17603-9731 |
Second Address | Lancaster, PA 17603-9731 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0225001 | CAPITAL BLUE CROSS (01) | PA |
1886077 | (05) | PA |
U85238 | (02) | PA |
UL1354609 | BLUE SHIELD (01) | PA |