Provider Demographics
NPI:1740806736
Name:RIGGLE, JOHN DAVID (CRS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:DAVID
Last Name:RIGGLE
Suffix:
Gender:M
Credentials:CRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 CENTURY BLVD STE 307
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37214-3692
Mailing Address - Country:US
Mailing Address - Phone:615-425-0220
Mailing Address - Fax:
Practice Address - Street 1:131 W EDWIN ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-6131
Practice Address - Country:US
Practice Address - Phone:570-505-8331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-25
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA12436175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist