Provider Demographics
NPI:1275761058
Name:RIETVELD, LINDA (DC)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:
Last Name:RIETVELD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 WAVERLY HALL CIR
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-5609
Mailing Address - Country:US
Mailing Address - Phone:678-799-0607
Mailing Address - Fax:
Practice Address - Street 1:290 WAVERLY HALL CIR
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-5609
Practice Address - Country:US
Practice Address - Phone:678-799-0607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-30
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7717111N00000X, 111NN1001X
GACHIR006060111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NN1001XChiropractic ProvidersChiropractorNutrition