Organization
INJURY REHAB CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MIGUEL G RIDGLEY D.C. (OWNER)
(504) 340-8700
Entity
Organization
Contact information
Practice address
4700 WICHERS DR, SUITE 307, MARRERO, LA 70072-3041
(504) 340-8700
(504) 340-8701
Mailing address
4700 WICHERS DR, SUITE 307, MARRERO, LA 70072-3041
(504) 340-8700
(504) 340-8701
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
1383
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2160907
—
LA
Enumeration date
09/22/2011
Last updated
09/22/2011
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