| Organization Name: | RIVERSIDE OSTEOPATHY LLC |
| NPI Number: | 1780030502 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | GARRETT B EDWARDS (OWNER) |
| Mailing Address: | 40 Main St Suite 131 Biddeford |
| State: | ME US |
| Postal Code: | 040055173 |
| Phone Number: | 2078998130 |
| Fax Number: | 2075588258 |
| NPI Enumeration Date: | 05/11/2016 |
| NPI Last Update Date: | 05/11/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 204D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Neuromusculoskeletal Medicine & OMM |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |