Provider Demographics
NPI:1366719148
Name:RIDDLE, SHAUN (ND)
Entity type:Individual
Prefix:DR
First Name:SHAUN
Middle Name:
Last Name:RIDDLE
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 NEILL AVE
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-3330
Mailing Address - Country:US
Mailing Address - Phone:406-442-8508
Mailing Address - Fax:
Practice Address - Street 1:33 NEILL AVE
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-3330
Practice Address - Country:US
Practice Address - Phone:406-442-8508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-22
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTAHC-NAT-LIC-1811175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath