Provider Demographics
NPI:1275409427
Name:RILEY, SAMANTHA JANE (DC)
Entity type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:JANE
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 1:11806 MILLBROOK RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19154-3711
Mailing Address - Country:US
Mailing Address - Phone:602-697-2548
Mailing Address - Fax:
Practice Address - Street 1:3300 GRANT AVE STE 20
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-2632
Practice Address - Country:US
Practice Address - Phone:888-245-8488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-15
Last Update Date:2025-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC012075111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor