Provider Demographics
NPI:1689904989
Name:LAURIE RILEY P.L.C.
Entity Type:Organization
Organization Name:LAURIE RILEY P.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:602-992-9791
Mailing Address - Street 1:4550 E BELL RD
Mailing Address - Street 2:BLDG 6 STE 152
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-9306
Mailing Address - Country:US
Mailing Address - Phone:602-992-9791
Mailing Address - Fax:
Practice Address - Street 1:4550 E BELL RD
Practice Address - Street 2:BLDG 6 STE 152
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-9306
Practice Address - Country:US
Practice Address - Phone:602-992-9791
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-08
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ80198Medicare PIN
AZU92308Medicare UPIN