Provider Demographics
NPI:1639245566
Name:RIDEN, JAMES RICHARDSON (DC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:RICHARDSON
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 1:123 NE WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74006-1635
Mailing Address - Country:US
Mailing Address - Phone:918-333-3354
Mailing Address - Fax:918-333-3355
Practice Address - Street 1:123 NE WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-1635
Practice Address - Country:US
Practice Address - Phone:918-333-3354
Practice Address - Fax:918-333-3355
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3220111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U51105Medicare UPIN