Provider Demographics
NPI:1730689837
Name:BRIDEGET N URBAN DC LLC
Entity type:Organization
Organization Name:BRIDEGET N URBAN DC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIDGETT
Authorized Official - Middle Name:NOEL
Authorized Official - Last Name:URBAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:330-360-2225
Mailing Address - Street 1:3958 HARBOR LIGHT LANDING
Mailing Address - Street 2:
Mailing Address - City:PORT CLINTON
Mailing Address - State:OH
Mailing Address - Zip Code:43452-3876
Mailing Address - Country:US
Mailing Address - Phone:330-360-2225
Mailing Address - Fax:
Practice Address - Street 1:3958 HARBOR LIGHT LANDING
Practice Address - Street 2:
Practice Address - City:PORT CLINTON
Practice Address - State:OH
Practice Address - Zip Code:43452-3876
Practice Address - Country:US
Practice Address - Phone:330-360-2225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-15
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2215111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2099349Medicaid
OHH257000OtherMEDICARE PIN