Provider Demographics
NPI:1508875253
Name:RILEY, JAMES RANDALL (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:RANDALL
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 1:1318 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:BIG SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:79720-3302
Mailing Address - Country:US
Mailing Address - Phone:432-263-6185
Mailing Address - Fax:432-264-9644
Practice Address - Street 1:1318 E. 4TH ST.
Practice Address - Street 2:
Practice Address - City:BIG SPRING
Practice Address - State:TX
Practice Address - Zip Code:79720-3302
Practice Address - Country:US
Practice Address - Phone:432-263-6185
Practice Address - Fax:432-264-9644
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8736111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX042015001Medicaid
TXP00009556OtherRAILROAD MEDICARE PROV. #
TX8A5350OtherBC/BS TX PROVIDER NUMBER
TX8336M0Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
TXU82698Medicare UPIN