Provider Demographics
NPI:1578638987
Name:RILEY, MARK L III (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:L
Last Name:RILEY
Suffix:III
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 1:2966 HARRISBURG RD NE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44705-2562
Mailing Address - Country:US
Mailing Address - Phone:330-452-3335
Mailing Address - Fax:330-452-9636
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:330-452-9636
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2063111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0128221Medicaid
OH0128221Medicaid
OH0758132Medicare PIN