Provider Demographics
NPI:1831697523
Name:RIEDEL, CHRISTOPHER ERIC (DC)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:ERIC
Last Name:RIEDEL
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 1:12041 DESSAU RD APT 205
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78754-1703
Mailing Address - Country:US
Mailing Address - Phone:518-256-0256
Mailing Address - Fax:
Practice Address - Street 1:10626 LINKWOOD CT
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-2965
Practice Address - Country:US
Practice Address - Phone:225-367-6164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-27
Last Update Date:2018-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13642111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor