Provider Demographics
NPI:1730361353
Name:RIDGEWAY, JENEEN (DC)
Entity type:Individual
Prefix:DR
First Name:JENEEN
Middle Name:
Last Name:RIDGEWAY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 SWANSON RD
Mailing Address - Street 2:
Mailing Address - City:TYRONE
Mailing Address - State:GA
Mailing Address - Zip Code:30290-6900
Mailing Address - Country:US
Mailing Address - Phone:770-964-5230
Mailing Address - Fax:770-964-5260
Practice Address - Street 1:510 SWANSON RD
Practice Address - Street 2:
Practice Address - City:TYRONE
Practice Address - State:GA
Practice Address - Zip Code:30290-6900
Practice Address - Country:US
Practice Address - Phone:770-964-5230
Practice Address - Fax:770-964-5230
Is Sole Proprietor?:No
Enumeration Date:2007-12-05
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008061111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor