Provider Demographics
NPI:1821311309
Name:RILEY, JANA D (DC)
Entity Type:Individual
Prefix:DR
First Name:JANA
Middle Name:D
Last Name:RILEY
Suffix:
Gender:F
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:PO BOX 354
Mailing Address - Street 2:
Mailing Address - City:KARLSTAD
Mailing Address - State:MN
Mailing Address - Zip Code:56732
Mailing Address - Country:US
Mailing Address - Phone:218-478-4975
Mailing Address - Fax:
Practice Address - Street 1:205 ROOSEVELT AVENUE
Practice Address - Street 2:
Practice Address - City:KARLSTAD
Practice Address - State:MN
Practice Address - Zip Code:56732
Practice Address - Country:US
Practice Address - Phone:218-791-9641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5348111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor