Provider Demographics
NPI:1356323752
Name:RIDEN, MICHAEL CHRISTOPHER (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:CHRISTOPHER
Last Name:RIDEN
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 1:1180 NORTH HILLS SHOPPINGCENTRE
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-1864
Mailing Address - Country:US
Mailing Address - Phone:580-332-8200
Mailing Address - Fax:580-332-8230
Practice Address - Street 1:1180 NORTH HILLS SHOPPINGCENTRE
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-1864
Practice Address - Country:US
Practice Address - Phone:580-332-8200
Practice Address - Fax:580-332-8230
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3740111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKV06431Medicare UPIN