Provider Demographics
NPI:1437287083
Name:RILEY CHIROPRACTIC INC
Entity Type:Organization
Organization Name:RILEY CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:L
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:330-452-3335
Mailing Address - Street 1:4269 WALTERSON AVE NW
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-1314
Mailing Address - Country:US
Mailing Address - Phone:330-837-4655
Mailing Address - Fax:
Practice Address - Street 1:2966 HARRISBURG RD NE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44705-2562
Practice Address - Country:US
Practice Address - Phone:330-452-3335
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2063111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty