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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