Provider Demographics
NPI:1639575343
Name:RIORDAN CLINIC, INC.
Entity Type:Organization
Organization Name:RIORDAN CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NATUROPATHIC DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:MACKIE
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:316-259-6409
Mailing Address - Street 1:3100 N HILLSIDE ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67219-3904
Mailing Address - Country:US
Mailing Address - Phone:316-682-3100
Mailing Address - Fax:316-618-8537
Practice Address - Street 1:3100 N HILLSIDE ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67219-3904
Practice Address - Country:US
Practice Address - Phone:316-682-3100
Practice Address - Fax:316-618-8537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-06
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS21-00036175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty