Provider Demographics
NPI:1659763548
Name:CULLINANE, RILEY SEAN (DC)
Entity Type:Individual
Prefix:
First Name:RILEY
Middle Name:SEAN
Last Name:CULLINANE
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 1:1105 HIAWATHA AVE APT 102
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55343-8164
Mailing Address - Country:US
Mailing Address - Phone:218-851-3422
Mailing Address - Fax:
Practice Address - Street 1:1865 W WAYZATA BLVD
Practice Address - Street 2:
Practice Address - City:LONG LAKE
Practice Address - State:MN
Practice Address - Zip Code:55356-9671
Practice Address - Country:US
Practice Address - Phone:952-473-3588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-02
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6061111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor