Provider Demographics
NPI:1326199241
Name:RIDDLE, DIANE (DC)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:
Last Name:RIDDLE
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 1:110 W CENTER ST
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49058-1881
Mailing Address - Country:US
Mailing Address - Phone:269-945-5441
Mailing Address - Fax:269-945-8804
Practice Address - Street 1:110 W CENTER ST
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MI
Practice Address - Zip Code:49058-1881
Practice Address - Country:US
Practice Address - Phone:269-945-5441
Practice Address - Fax:269-945-8804
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007688111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIDR007688OtherBCBSMI
MIOM63090001Medicare ID - Type UnspecifiedPROVIDER