Provider Demographics
NPI:1427067701
Name:RILEY CHIROPRACTIC HEALTH CENTER, P.C.
Entity type:Organization
Organization Name:RILEY CHIROPRACTIC HEALTH CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:RANDALL
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:432-263-6185
Mailing Address - Street 1:1318 E. 4TH ST.
Mailing Address - Street 2:
Mailing Address - City:BIG SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:79720-3302
Mailing Address - Country:US
Mailing Address - Phone:432-263-6185
Mailing Address - Fax:432-264-9644
Practice Address - Street 1:1318 E. 4TH ST.
Practice Address - Street 2:
Practice Address - City:BIG SPRING
Practice Address - State:TX
Practice Address - Zip Code:79720-3302
Practice Address - Country:US
Practice Address - Phone:432-263-6185
Practice Address - Fax:432-264-9644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8736111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDG6004OtherRAILROAD MEDICARE
TX0002EZOtherBC/BS TX GROUP #
TX079943901Medicaid
TX0002EZOtherBC/BS TX GROUP #