Provider Demographics
NPI:1669780052
Name:RIDDLE FAMILY CHIROPRACTIC, INC.
Entity type:Organization
Organization Name:RIDDLE FAMILY CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:RIDDLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:727-938-5322
Mailing Address - Street 1:4617 MILE STRETCH DR
Mailing Address - Street 2:
Mailing Address - City:HOLIDAY
Mailing Address - State:FL
Mailing Address - Zip Code:34690-4330
Mailing Address - Country:US
Mailing Address - Phone:727-938-5322
Mailing Address - Fax:727-943-9546
Practice Address - Street 1:4617 MILE STRETCH DR
Practice Address - Street 2:
Practice Address - City:HOLIDAY
Practice Address - State:FL
Practice Address - Zip Code:34690-4330
Practice Address - Country:US
Practice Address - Phone:727-938-5322
Practice Address - Fax:727-943-9546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-20
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0006712111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL380417800Medicaid
FL380417800Medicaid