Provider Demographics
NPI:1740648260
Name:RIES CHIROPRACTIC & REHABILITATION CENTER LLC
Entity type:Organization
Organization Name:RIES CHIROPRACTIC & REHABILITATION CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KENLY
Authorized Official - Middle Name:LEONARD
Authorized Official - Last Name:RIES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:928-537-2213
Mailing Address - Street 1:5658 HIGHWAY 260 STE 1
Mailing Address - Street 2:
Mailing Address - City:LAKESIDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85929-5189
Mailing Address - Country:US
Mailing Address - Phone:928-537-2213
Mailing Address - Fax:928-532-0013
Practice Address - Street 1:5658 HWY 260 STE 1
Practice Address - Street 2:
Practice Address - City:LAKESIDE
Practice Address - State:AZ
Practice Address - Zip Code:85929
Practice Address - Country:US
Practice Address - Phone:928-537-2213
Practice Address - Fax:928-532-0013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-29
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ140250Medicare PIN