Provider Demographics
NPI:1861573529
Name:RIDER, WARD E (DC)
Entity type:Individual
Prefix:DR
First Name:WARD
Middle Name:E
Last Name:RIDER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98-1258 KAAHUMANU ST STE 110
Mailing Address - Street 2:
Mailing Address - City:PEARL CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96782-3251
Mailing Address - Country:US
Mailing Address - Phone:808-487-2273
Mailing Address - Fax:808-488-3464
Practice Address - Street 1:98-1258 KAAHUMANU ST STE 110
Practice Address - Street 2:
Practice Address - City:PEARL CITY
Practice Address - State:HI
Practice Address - Zip Code:96782-3251
Practice Address - Country:US
Practice Address - Phone:808-487-2273
Practice Address - Fax:808-488-3464
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDC-367111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI9867-3OtherHMSA
HI55643Medicare ID - Type UnspecifiedMEDICARE NUMBER
HI9867-3OtherHMSA