Provider Demographics
NPI:1699942805
Name:S. RILEY CHIROPRACTIC PLLC
Entity type:Organization
Organization Name:S. RILEY CHIROPRACTIC PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:G
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:936-598-5200
Mailing Address - Street 1:201 SAN AUGUSTINE ST
Mailing Address - Street 2:
Mailing Address - City:CENTER
Mailing Address - State:TX
Mailing Address - Zip Code:75935-3953
Mailing Address - Country:US
Mailing Address - Phone:936-598-5200
Mailing Address - Fax:936-591-0505
Practice Address - Street 1:201 SAN AUGUSTINE ST
Practice Address - Street 2:
Practice Address - City:CENTER
Practice Address - State:TX
Practice Address - Zip Code:75935-3953
Practice Address - Country:US
Practice Address - Phone:936-598-5200
Practice Address - Fax:936-591-0505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-15
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9199111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX608231OtherBCBSTX
TX314448Medicare PIN