Provider Demographics
NPI:1992897920
Name:RILEY, SEAN O (DC)
Entity type:Individual
Prefix:MR
First Name:SEAN
Middle Name:O
Last Name:RILEY
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 1:3345 S HARVARD AVE
Mailing Address - Street 2:SUITE #101
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-1812
Mailing Address - Country:US
Mailing Address - Phone:918-743-3737
Mailing Address - Fax:918-728-8801
Practice Address - Street 1:3345 S HARVARD AVE
Practice Address - Street 2:SUITE #101
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-1812
Practice Address - Country:US
Practice Address - Phone:918-743-3737
Practice Address - Fax:918-728-8801
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3542111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor