Provider Demographics
NPI:1992910319
Name:RIDDEL, JOEL A (DC)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:A
Last Name:RIDDEL
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 1:1115 MINNESOTA AVE
Mailing Address - Street 2:
Mailing Address - City:LIBBY
Mailing Address - State:MT
Mailing Address - Zip Code:59923
Mailing Address - Country:US
Mailing Address - Phone:406-293-2741
Mailing Address - Fax:406-293-2741
Practice Address - Street 1:1115 MINNESOTA AVE
Practice Address - Street 2:
Practice Address - City:LIBBY
Practice Address - State:MT
Practice Address - Zip Code:59923
Practice Address - Country:US
Practice Address - Phone:406-293-2741
Practice Address - Fax:406-293-2741
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT907CHI111N00000X
WACH00034225111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTP00314296OtherRAILROAD MEDICARE
MT40453OtherBLUE CROSS
MT0164242Medicaid
MT0164254Medicaid
MT0164254Medicaid