1679654974 NPI number — DR. PAUL DAVID RIESELMAN DC, FNP-BC

Table of content: DR. PAUL DAVID RIESELMAN DC, FNP-BC (NPI 1679654974)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679654974 NPI number — DR. PAUL DAVID RIESELMAN DC, FNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIESELMAN
Provider First Name:
PAUL
Provider Middle Name:
DAVID
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC, FNP-BC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679654974
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/17/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4513 LINCOLN AVE
Provider Second Line Business Mailing Address:
SUITE 212
Provider Business Mailing Address City Name:
LISLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60532-1289
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-795-1889
Provider Business Mailing Address Fax Number:
630-281-2802

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4513 LINCOLN AVE
Provider Second Line Business Practice Location Address:
SUITE 212
Provider Business Practice Location Address City Name:
LISLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60532-1289
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-795-1889
Provider Business Practice Location Address Fax Number:
630-281-2802
Provider Enumeration Date:
10/17/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  038010007 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 209009686 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 364SF0001X , with the licence number: 209009686 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 364SA2200X , with the licence number: 209009686 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 364SC2300X , with the licence number: 209009686 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 364SH1100X , with the licence number: 209009686 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 364SN0800X , with the licence number: 209009686 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 364SX0106X , with the licence number: 209009686 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 364SR0400X , with the licence number: 209009686 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2200X , with the licence number: 209009686 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LG0600X , with the licence number: 209009686 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP2300X , with the licence number: 209009686 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WP0000X , with the licence number: 041384754 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 171100000X , with the licence number: 038010007 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111NX0800X , with the licence number: 038010007 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)