Provider Demographics
NPI:1689749970
Name:RILEY, TERRY (DC)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:
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 1:8555 STATION VILLAGE LN
Mailing Address - Street 2:STE B
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-6567
Mailing Address - Country:US
Mailing Address - Phone:619-284-3883
Mailing Address - Fax:619-295-1795
Practice Address - Street 1:4150 MISSION BLVD STE 145
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-5055
Practice Address - Country:US
Practice Address - Phone:858-272-3898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-24573111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor