Provider Demographics
NPI:1194736751
Name:RIKER, JOHN R (DC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:RIKER
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 1:398 FEURA BUSH RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:GLENMONT
Mailing Address - State:NY
Mailing Address - Zip Code:12077-2954
Mailing Address - Country:US
Mailing Address - Phone:518-618-5362
Mailing Address - Fax:518-449-3073
Practice Address - Street 1:398 FEURA BUSH RD
Practice Address - Street 2:SUITE 2
Practice Address - City:GLENMONT
Practice Address - State:NY
Practice Address - Zip Code:12077-2954
Practice Address - Country:US
Practice Address - Phone:518-618-5362
Practice Address - Fax:518-449-3073
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX005277-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY050582391OtherBSNENY/PRISM
NY050582391OtherMVPLANDMARK
NY1046936OtherAM. SPECIALITY HEALTH
NY050582391OtherEMPIRE PLAN
NY050582391OtherACN
NY10045225OtherCDPHP
NY050582391OtherUHC
NYX6C54XW121Medicare PIN
NYU82059Medicare UPIN