Provider Demographics
NPI:1558490524
Name:RIORDAN, JOHN J (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
Last Name:RIORDAN
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 1:420 EAST YOUNG AVENUE
Mailing Address - Street 2:
Mailing Address - City:WARRENSBURG
Mailing Address - State:MO
Mailing Address - Zip Code:64093
Mailing Address - Country:US
Mailing Address - Phone:660-422-7246
Mailing Address - Fax:660-422-7243
Practice Address - Street 1:420 EAST YOUNG AVENUE
Practice Address - Street 2:
Practice Address - City:WARRENSBURG
Practice Address - State:MO
Practice Address - Zip Code:64093
Practice Address - Country:US
Practice Address - Phone:660-422-7246
Practice Address - Fax:660-422-7243
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3042111N00000X
AZ5137111N00000X
HI991111N00000X
SC3070111N00000X
MO2008033989111N00000X
KS01-05237111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS26-4342081OtherTAX ID
KS26-4342081OtherTAX ID
ORU69417Medicare UPIN
MOMA2185Medicare UPIN