Individual
DR. DUSTIN DAVID RIDDLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC,DPM,MHA
Contact information
Practice address
W2654 COUNTY ROAD KK, APPLETON, WI 54915-9468
(920) 830-2221
Mailing address
W2654 COUNTY ROAD KK, APPLETON, WI 54915-9468
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
3880-012
WI
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
1127-25
WI
213ES0103X
Foot & Ankle Surgery Podiatrist
135000875
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38961800
—
WI
Enumeration date
08/19/2006
Last updated
04/26/2018
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