Provider Demographics
NPI:1093045106
Name:RIGGS, MARK R II (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:R
Last Name:RIGGS
Suffix:II
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:MARK
Other - Middle Name:
Other - Last Name:RIGGS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:1530 S VAL VISTA DR STE 106
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-3860
Mailing Address - Country:US
Mailing Address - Phone:972-854-9960
Mailing Address - Fax:
Practice Address - Street 1:1530 S VAL VISTA DR STE 106
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296
Practice Address - Country:US
Practice Address - Phone:972-854-9960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-12
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8800111N00000X
TX11397111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX107286Medicare PIN