Provider Demographics
NPI:1881423721
Name:SMITH, RILEY JOEL
Entity type:Individual
Prefix:
First Name:RILEY
Middle Name:JOEL
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15400 CHENAL PKWY STE 120
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-2297
Mailing Address - Country:US
Mailing Address - Phone:501-400-7700
Mailing Address - Fax:
Practice Address - Street 1:16000 RUSHMORE AVE APT 8204
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223-7007
Practice Address - Country:US
Practice Address - Phone:870-397-4648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR12414111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor