Provider Demographics
NPI:1871666032
Name:RIFFEL, EDWARD (DC)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:RIFFEL
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 1:67200 VAN DYKE RD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48095-1463
Mailing Address - Country:US
Mailing Address - Phone:586-752-5001
Mailing Address - Fax:
Practice Address - Street 1:67200 VAN DYKE RD
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:MI
Practice Address - Zip Code:48095-1463
Practice Address - Country:US
Practice Address - Phone:586-752-5001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIER002846111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU28851Medicare UPIN
MI0E05014Medicare ID - Type Unspecified