Provider Demographics
NPI:1821080227
Name:RILEY, ROBERT ALAN (DC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ALAN
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 1:1225 SW SUMMIT HILL DR
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64081-3270
Mailing Address - Country:US
Mailing Address - Phone:816-516-2864
Mailing Address - Fax:
Practice Address - Street 1:1225 SW SUMMIT HILL DR
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64081-3270
Practice Address - Country:US
Practice Address - Phone:816-516-2864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-22
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001023492111N00000X, 171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOK67000033Medicare UPIN
008B269Medicare ID - Type Unspecified
U86622Medicare UPIN