Provider Demographics
NPI:1003826850
Name:RILEY, RICHARD (DC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:RILEY
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 1:1100 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72201-2008
Mailing Address - Country:US
Mailing Address - Phone:501-371-0022
Mailing Address - Fax:501-371-0810
Practice Address - Street 1:1100 W 3RD ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72201-2008
Practice Address - Country:US
Practice Address - Phone:501-371-0022
Practice Address - Fax:501-371-0810
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR887111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR59798OtherBLUE CROSS/BLUE SHIELD
AR59798OtherHEALTH ADVANTAGE
AR14434000040OtherQUALCHOICE
350022129OtherRAID ROAD MEDICARE
AR59798OtherBLUE ADVANTAGE
AR59798OtherFIRST SOURCE
AR59798OtherHEALTH ADVANTAGE