Provider Demographics
NPI:1205885381
Name:RIECK, DANIEL EDWARD (DC)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:EDWARD
Last Name:RIECK
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 1:11943 N WILLIAMS STREET
Mailing Address - Street 2:SUITE B
Mailing Address - City:DUNNELLON
Mailing Address - State:FL
Mailing Address - Zip Code:34432-8342
Mailing Address - Country:US
Mailing Address - Phone:352-465-3686
Mailing Address - Fax:352-465-6877
Practice Address - Street 1:11943 N WILLIAMS STREET
Practice Address - Street 2:SUITE B
Practice Address - City:DUNNELLON
Practice Address - State:FL
Practice Address - Zip Code:34432-8342
Practice Address - Country:US
Practice Address - Phone:352-465-3686
Practice Address - Fax:352-465-6877
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8136111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1963422OtherFIRST HEALTH NETWORK
FL53961OtherBLUECROSS BLUESHIELD
FL1963422OtherFIRST HEALTH NETWORK
FLU85377Medicare UPIN