Provider Demographics
NPI:1699897603
Name:RIGGERT, GREGG LOREN (DC)
Entity type:Individual
Prefix:DR
First Name:GREGG
Middle Name:LOREN
Last Name:RIGGERT
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 1:24 CLUB MANOR DR STE 108
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-1699
Mailing Address - Country:US
Mailing Address - Phone:719-295-1151
Mailing Address - Fax:719-542-1098
Practice Address - Street 1:24 CLUB MANOR DR STE 108
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-1699
Practice Address - Country:US
Practice Address - Phone:719-295-1151
Practice Address - Fax:719-542-1098
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4018111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor