Provider Demographics
NPI:1306863899
Name:RIFFLE, DANA CARL (DC)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:CARL
Last Name:RIFFLE
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 1:110 WEST CHESTNUT STREET
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050
Mailing Address - Country:US
Mailing Address - Phone:740-392-7861
Mailing Address - Fax:740-392-7861
Practice Address - Street 1:110 WEST CHESTNUT STREET
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050
Practice Address - Country:US
Practice Address - Phone:740-392-7861
Practice Address - Fax:740-392-7861
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1759111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0929937Medicaid
U20633Medicare UPIN
OH0929937Medicaid