Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 007930L | PA |
NPI | 1205897816 |
---|---|
Provider Name | Matthew J. Ritter |
First Address | Bloomsburg, PA 17815-3023 |
Second Address | Bloomsburg, PA 17815-3023 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2006 |
Last Update Date | 06/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01848001 | CAPITAL BLUE CROSS (01) | PA |
0512334000 | INDEPENDENCE BLUE CROSS (01) | PA |
468873 | HIGHMARK BLUE SHIELD (01) | PA |