Provider Demographics
NPI:1225159569
Name:RILEY, CONSTANCE JEAN (DC)
Entity Type:Individual
Prefix:DR
First Name:CONSTANCE
Middle Name:JEAN
Last Name:RILEY
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 1:4134 RODEO DR
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-3280
Mailing Address - Country:US
Mailing Address - Phone:419-367-3113
Mailing Address - Fax:
Practice Address - Street 1:4400 HEATHERDOWNS BLVD STE 5
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-3182
Practice Address - Country:US
Practice Address - Phone:419-720-1472
Practice Address - Fax:419-720-1475
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3553111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor