Provider Demographics
NPI:1447367412
Name:RIEDIGER, SANDRA (DC)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:
Last Name:RIEDIGER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 OCEAN PARK BLVD
Mailing Address - Street 2:#207
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405
Mailing Address - Country:US
Mailing Address - Phone:310-396-2245
Mailing Address - Fax:310-396-6736
Practice Address - Street 1:2901 OCEAN PARK BLVD
Practice Address - Street 2:#207
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405
Practice Address - Country:US
Practice Address - Phone:310-396-2245
Practice Address - Fax:310-396-6736
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC17801111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U49957Medicare UPIN