Organization
DDMR PLLC
Active
Organization
DDMR PLLC
Active
Other names
Health Source of Monroe
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL RICCOBONI D.C. (ORGANIZING MEMBER)
(336) 766-5935
Entity
Organization
Contact information
Practice address
1309 E SUNSET DR, MONROE, NC 28112-4324
(704) 296-9090
Mailing address
420 UTILITY DR, CLEMMONS, NC 27012-8397
(336) 766-5935
(336) 766-5365
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
3062
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
085HM
—
NC
01
—
1013998848
NPI
NC
01
—
1477587947
NPI
NC
05
—
890833W
—
NC
Enumeration date
11/08/2010
Last updated
11/08/2010
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