Provider Demographics
NPI:1326650029
Name:RIDDLE, PETER GILMER (DC)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:GILMER
Last Name:RIDDLE
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 1:6381 S CHALKVILLE RD
Mailing Address - Street 2:
Mailing Address - City:TRUSSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35173-6304
Mailing Address - Country:US
Mailing Address - Phone:205-661-6600
Mailing Address - Fax:205-661-6601
Practice Address - Street 1:6381 S CHALKVILLE RD
Practice Address - Street 2:
Practice Address - City:TRUSSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35173-6304
Practice Address - Country:US
Practice Address - Phone:205-661-6600
Practice Address - Fax:205-661-6601
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2654111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty