Healthcare Provider Details
I. General information
NPI: 1679654974
Provider Name (Legal Business Name): PAUL DAVID RIESELMAN DC, FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 10/17/2006
Last Update Date: 12/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
4513 LINCOLN AVE SUITE 212
LISLE IL
60532-1289
US
IV. Provider business mailing address
4513 LINCOLN AVE SUITE 212
LISLE IL
60532-1289
US
V. Phone/Fax
- Phone: 630-795-1889
- Fax: 630-281-2802
- Phone: 630-795-1889
- Fax: 630-281-2802
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 111N00000X |
| Taxonomy | Chiropractor |
| License Number | 038010007 |
| License Number State | IL |
| # 2 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 363LF0000X |
| Taxonomy | Family Nurse Practitioner |
| License Number | 209009686 |
| License Number State | IL |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 364SF0001X |
| Taxonomy | Family Health Clinical Nurse Specialist |
| License Number | 209009686 |
| License Number State | IL |
| # 4 | |
| Primary Taxonomy | N |
| Taxonomy Code | 364SA2200X |
| Taxonomy | Adult Health Clinical Nurse Specialist |
| License Number | 209009686 |
| License Number State | IL |
| # 5 | |
| Primary Taxonomy | N |
| Taxonomy Code | 364SC2300X |
| Taxonomy | Chronic Care Clinical Nurse Specialist |
| License Number | 209009686 |
| License Number State | IL |
| # 6 | |
| Primary Taxonomy | N |
| Taxonomy Code | 364SH1100X |
| Taxonomy | Holistic Clinical Nurse Specialist |
| License Number | 209009686 |
| License Number State | IL |
| # 7 | |
| Primary Taxonomy | N |
| Taxonomy Code | 364SN0800X |
| Taxonomy | Neuroscience Clinical Nurse Specialist |
| License Number | 209009686 |
| License Number State | IL |
| # 8 | |
| Primary Taxonomy | N |
| Taxonomy Code | 364SX0106X |
| Taxonomy | Occupational Health Clinical Nurse Specialist |
| License Number | 209009686 |
| License Number State | IL |
| # 9 | |
| Primary Taxonomy | N |
| Taxonomy Code | 364SR0400X |
| Taxonomy | Rehabilitation Clinical Nurse Specialist |
| License Number | 209009686 |
| License Number State | IL |
| # 10 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363LA2200X |
| Taxonomy | Adult Health Nurse Practitioner |
| License Number | 209009686 |
| License Number State | IL |
| # 11 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363LG0600X |
| Taxonomy | Gerontology Nurse Practitioner |
| License Number | 209009686 |
| License Number State | IL |
| # 12 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363LP2300X |
| Taxonomy | Primary Care Nurse Practitioner |
| License Number | 209009686 |
| License Number State | IL |
| # 13 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WP0000X |
| Taxonomy | Pain Management Registered Nurse |
| License Number | 041384754 |
| License Number State | IL |
| # 14 | |
| Primary Taxonomy | N |
| Taxonomy Code | 171100000X |
| Taxonomy | Acupuncturist |
| License Number | 038010007 |
| License Number State | IL |
| # 15 | |
| Primary Taxonomy | N |
| Taxonomy Code | 111NX0800X |
| Taxonomy | Orthopedic Chiropractor |
| License Number | 038010007 |
| License Number State | IL |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
