Provider Demographics
NPI:1407091689
Name:RIERAMEDINA, DANIEL ENRIQUE
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ENRIQUE
Last Name:RIERAMEDINA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 HIGHWAY 13 E APT 314
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-4819
Mailing Address - Country:US
Mailing Address - Phone:612-237-2508
Mailing Address - Fax:
Practice Address - Street 1:120 HIGHWAY 13 E
Practice Address - Street 2:314
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-4812
Practice Address - Country:US
Practice Address - Phone:612-237-2508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-02
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5157111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor