Provider Demographics
NPI:1881800670
Name:RIDDEL, JOHN STUART (DC)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:STUART
Last Name:RIDDEL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1800 OAK PARK BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-4479
Mailing Address - Country:US
Mailing Address - Phone:925-945-7890
Mailing Address - Fax:925-945-7890
Practice Address - Street 1:6480 E MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-2391
Practice Address - Country:US
Practice Address - Phone:614-864-1611
Practice Address - Fax:614-864-4573
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4279111N00000X
CADC16829111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor