Provider Demographics
NPI:1659401040
Name:RILEY, JUDY EILEEN (DC)
Entity Type:Individual
Prefix:DR
First Name:JUDY
Middle Name:EILEEN
Last Name:RILEY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 E IMPERIAL HWY
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-1718
Mailing Address - Country:US
Mailing Address - Phone:714-524-6990
Mailing Address - Fax:
Practice Address - Street 1:1255 E. IMPERIAL HWY.
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-1718
Practice Address - Country:US
Practice Address - Phone:714-524-6990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20763111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC20763Medicare ID - Type Unspecified
CAU47888Medicare UPIN