Provider Demographics
NPI:1477512218
Name:LITTLE ROCK CHIROPRACTIC CLINIC, P.A.
Entity Type:Organization
Organization Name:LITTLE ROCK CHIROPRACTIC CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:501-371-0022
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR887111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR59798OtherBLUE CROSS/BLUE SHIELD
AR14434000040OtherQUALCHOICE
AR59798OtherHEEALTH ADVANTAGE
AR59798OtherFIRST SOURCE
AR59798OtherBLUE ADVANTAGE
350022129OtherRAIL ROAD MEDICARE
AR59798OtherHEEALTH ADVANTAGE