Provider Demographics
NPI:1255870119
Name:RIASE, DANIEL (DC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:RIASE
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 1:3000 WINDY HILL RD SE
Mailing Address - Street 2:UNIT 674591
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30006-0201
Mailing Address - Country:US
Mailing Address - Phone:678-649-2131
Mailing Address - Fax:678-649-2132
Practice Address - Street 1:3915 CASCADE RD SW STE T-155
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-8512
Practice Address - Country:US
Practice Address - Phone:678-649-2131
Practice Address - Fax:678-649-2132
Is Sole Proprietor?:No
Enumeration Date:2017-02-13
Last Update Date:2021-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2553-I111N00000X
GACHIR009897111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA14097985OtherCAQH