Provider Demographics
NPI:1285872572
Name:RIEDL, TYLER RAY (DC)
Entity type:Individual
Prefix:DR
First Name:TYLER
Middle Name:RAY
Last Name:RIEDL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 W SANTA FE TRAIL BLVD
Mailing Address - Street 2:PO BOX 213
Mailing Address - City:LAKIN
Mailing Address - State:KS
Mailing Address - Zip Code:67860-9454
Mailing Address - Country:US
Mailing Address - Phone:620-355-4116
Mailing Address - Fax:620-355-4117
Practice Address - Street 1:306 W SANTA FE TRAIL BLVD
Practice Address - Street 2:
Practice Address - City:LAKIN
Practice Address - State:KS
Practice Address - Zip Code:67860-9454
Practice Address - Country:US
Practice Address - Phone:620-355-4116
Practice Address - Fax:620-355-4117
Is Sole Proprietor?:No
Enumeration Date:2009-01-26
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05387111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor