Provider Demographics
NPI:1396722104
Name:RIES, MICAH DAVID (DC)
Entity type:Individual
Prefix:DR
First Name:MICAH
Middle Name:DAVID
Last Name:RIES
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 1:6611 ARLINGTON AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-1924
Mailing Address - Country:US
Mailing Address - Phone:951-359-1229
Mailing Address - Fax:
Practice Address - Street 1:6611 ARLINGTON AVE
Practice Address - Street 2:SUITE E
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504-1924
Practice Address - Country:US
Practice Address - Phone:951-359-1229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-22
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29448111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor