Doctor Name: | DR. GLENN PAUL RIDDLE |
NPI Number: | 1649223280 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | DC |
License Number: | 0006712 |
Business Practice Address: | 4617 Mile Stretch Dr Holiday, FL - 346904330 |
Business Phone Number: | 7279385322 |
Business Fax Number: | 7279439546 |
Mailing Address: | 4617 Mile Stretch Dr, HOLIDAY |
State: | FL |
Postal Code: | 346904330 |
Phone Number: | 7279385322 |
Fax Number: | 7279439546 |
NPI Enumeration Date: | 05/17/2006 |
NPI Last Update Date: | 08/16/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 111N00000X |
License Number: | 0006712 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Chiropractic Providers |
Taxonomy Classification: | Chiropractor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |