Provider Demographics
NPI:1902011471
Name:RILEY, MELISSA KAE (DC)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:KAE
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 1:321 SHOFFSTALL RD
Mailing Address - Street 2:
Mailing Address - City:BROOKVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15825-8771
Mailing Address - Country:US
Mailing Address - Phone:814-220-0028
Mailing Address - Fax:814-226-7076
Practice Address - Street 1:44 N 1ST AVENUE.
Practice Address - Street 2:SUITE B
Practice Address - City:CLARION
Practice Address - State:PA
Practice Address - Zip Code:16214
Practice Address - Country:US
Practice Address - Phone:814-226-5600
Practice Address - Fax:814-226-5611
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009147111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARI1640808OtherHIGHMARK BLUE SHIELD
PA001641310OtherHIGHMARK BLUE SHIELD
PARI1640808OtherHIGHMARK BLUE SHIELD
PA001641310OtherHIGHMARK BLUE SHIELD
PA083178Medicare PIN