Provider Demographics
NPI:1588799225
Name:CORBETT R. RILEY, DC, A CHIROPRACTIC CORPORATION
Entity Type:Organization
Organization Name:CORBETT R. RILEY, DC, A CHIROPRACTIC CORPORATION
Other - Org Name:GRASS VALLEY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR BUSINESS OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CORBETT
Authorized Official - Middle Name:R
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:530-477-8081
Mailing Address - Street 1:104 CATHERINE LN
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-5701
Mailing Address - Country:US
Mailing Address - Phone:530-477-8081
Mailing Address - Fax:530-477-8081
Practice Address - Street 1:104 CATHERINE LN
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5701
Practice Address - Country:US
Practice Address - Phone:530-477-8081
Practice Address - Fax:530-477-8081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19960111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty