Provider Demographics
NPI:1407988850
Name:MCRAE, RILEY LLEWELLYN (DC)
Entity Type:Individual
Prefix:DR
First Name:RILEY
Middle Name:LLEWELLYN
Last Name:MCRAE
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 1:212 SANDERS ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35611-1420
Mailing Address - Country:US
Mailing Address - Phone:256-232-5221
Mailing Address - Fax:
Practice Address - Street 1:212 SANDERS ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35611-1420
Practice Address - Country:US
Practice Address - Phone:256-232-5221
Practice Address - Fax:256-232-5221
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1606111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor