Healthcare Provider Details

I. General information

NPI: 1740359165
Provider Name (Legal Business Name): RAE LYNN RIEDEL D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6825 E HAMPDEN AVE STE 100
DENVER CO
80224-3000
US

IV. Provider business mailing address

6825 E HAMPDEN AVE STE 100
DENVER CO
80224-3000
US

V. Phone/Fax

Practice location:
  • Phone: 303-758-2638
  • Fax: 303-758-2633
Mailing address:
  • Phone: 303-758-2638
  • Fax: 303-758-2633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3150
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: