Individual
DR. MICHAEL JOHN RICCOBONI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
6774 RIVER CENTER DRIVE, CLEMMONS, NC 27012-8999
(336) 766-5935
(336) 766-5365
Mailing address
6774 RIVER CENTER DRIVE, CLEMMONS, NC 27012-8999
(336) 766-5935
(336) 766-5365
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
3062
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
085HM
BLUECROSS/BLUE SHIELD NUM
NC
01
—
41-2094316
ALL OTHER NETWORKS
—
01
—
648441
ACN PROVIDER NUMBER
—
05
—
89085HM
—
NC
Enumeration date
11/09/2005
Last updated
11/10/2011
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