Provider Demographics
NPI:1295730034
Name:RILEY, WILLIAM DAN (DC)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:DAN
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 1:14 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:MI
Mailing Address - Zip Code:48160-1214
Mailing Address - Country:US
Mailing Address - Phone:734-439-2434
Mailing Address - Fax:
Practice Address - Street 1:14 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:MI
Practice Address - Zip Code:48160-1214
Practice Address - Country:US
Practice Address - Phone:734-439-2434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-17
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301003017111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIT33641Medicare UPIN
MI0H15040Medicare ID - Type Unspecified