Provider Demographics
NPI:1184132284
Name:RIECKER, ZACHARY ROBERT (DC)
Entity type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:ROBERT
Last Name:RIECKER
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 1:11802 N 56TH ST
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33617-1652
Mailing Address - Country:US
Mailing Address - Phone:813-985-1322
Mailing Address - Fax:
Practice Address - Street 1:11802 N 56TH ST
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33617-1652
Practice Address - Country:US
Practice Address - Phone:551-427-4435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-11
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011336111N00000X
FLCH14268111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty