Provider Demographics
NPI:1487656369
Name:RILEY, ANDREW J (DC)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:J
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 1:489 S STATE ROAD 135
Mailing Address - Street 2:STE. A
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-1400
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:489 S STATE ROAD 135
Practice Address - Street 2:STE. A
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-1400
Practice Address - Country:US
Practice Address - Phone:317-889-8998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001919A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN184280AMedicare ID - Type Unspecified