Provider Demographics
NPI:1023753704
Name:MIX-RIDDLE CHIROPRACTIC LLC
Entity type:Organization
Organization Name:MIX-RIDDLE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:GILMER
Authorized Official - Last Name:RIDDLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:205-907-5259
Mailing Address - Street 1:6381 S CHALKVILLE RD
Mailing Address - Street 2:
Mailing Address - City:TRUSSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35173-6304
Mailing Address - Country:US
Mailing Address - Phone:205-661-6600
Mailing Address - Fax:205-661-6601
Practice Address - Street 1:6381 S CHALKVILLE RD
Practice Address - Street 2:
Practice Address - City:TRUSSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35173-6304
Practice Address - Country:US
Practice Address - Phone:205-661-6600
Practice Address - Fax:205-661-6601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-28
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty