Provider Demographics
NPI:1083086128
Name:RIECK CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:RIECK CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:RIECK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:352-465-3686
Mailing Address - Street 1:20212 E PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:DUNNELLON
Mailing Address - State:FL
Mailing Address - Zip Code:34432
Mailing Address - Country:US
Mailing Address - Phone:352-465-3686
Mailing Address - Fax:
Practice Address - Street 1:20212 E PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:DUNNELLON
Practice Address - State:FL
Practice Address - Zip Code:34432-6032
Practice Address - Country:US
Practice Address - Phone:352-465-3686
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8136111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK2657OtherCHIROPRACTOR