MEDICARE: DR. REGAN RIDDLE DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CH13934	FL
2	111N00000X	Chiropractor	4855	SC

General Provider Information

NPI Number	:	1902552821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. REGAN RIDDLE DC

Provider Business Mailing Address
First Line	:	3845 ESPLANADE AVE
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32129-6023
Country	:	US
Telephone Number	:	334-322-4419
Fax Number	:

Provider Business Practice Location Address
First Line	:	1661 CELANESE RD
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29732-1728
Country	:	US
Telephone Number	:	803-329-8266
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/01/2022
Last Update Date	:	09/18/2022

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