Provider Demographics
NPI:1679654974
Name:RIESELMAN, PAUL DAVID (DC, FNP-BC)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:DAVID
Last Name:RIESELMAN
Suffix:
Gender:M
Credentials:DC, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4513 LINCOLN AVE
Mailing Address - Street 2:SUITE 212
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-1289
Mailing Address - Country:US
Mailing Address - Phone:630-795-1889
Mailing Address - Fax:630-281-2802
Practice Address - Street 1:4513 LINCOLN AVE
Practice Address - Street 2:SUITE 212
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-1289
Practice Address - Country:US
Practice Address - Phone:630-795-1889
Practice Address - Fax:630-281-2802
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038010007111N00000X, 171100000X, 111NX0800X
IL209009686363LF0000X, 364SF0001X, 364SA2200X, 364SC2300X, 364SH1100X, 364SN0800X, 364SX0106X, 364SR0400X, 363LA2200X, 363LG0600X, 363LP2300X
IL041384754163WP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No111N00000XChiropractic ProvidersChiropractor
No364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
No364SC2300XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistChronic Care
No364SH1100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistHolistic
No364SN0800XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistNeuroscience
No364SX0106XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistOccupational Health
No364SR0400XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistRehabilitation
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163WP0000XNursing Service ProvidersRegistered NursePain Management
No171100000XOther Service ProvidersAcupuncturist
No111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK16881Medicare PIN
ILU97446Medicare UPIN