Provider Demographics
NPI:1750652053
Name:RILEY, LEVY III (DC)
Entity Type:Individual
Prefix:DR
First Name:LEVY
Middle Name:
Last Name:RILEY
Suffix:III
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 1:9658 BALTIMORE AVE
Mailing Address - Street 2:STE 420
Mailing Address - City:COLLEGE PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20740-1358
Mailing Address - Country:US
Mailing Address - Phone:301-577-6556
Mailing Address - Fax:
Practice Address - Street 1:7400 RIVERDALE RD
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-1136
Practice Address - Country:US
Practice Address - Phone:301-577-6556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-18
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 10473111N00000X
MDS03768111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor