Healthcare Provider Details

I. General information

NPI: 1881423721
Provider Name (Legal Business Name): RILEY JOEL SMITH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2024
Last Update Date: 07/30/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16000 RUSHMORE AVE APT 8204
LITTLE ROCK AR
72223-7007
US

IV. Provider business mailing address

15400 CHENAL PKWY STE 120
LITTLE ROCK AR
72211-2297
US

V. Phone/Fax

Practice location:
  • Phone: 870-397-4648
  • Fax:
Mailing address:
  • Phone: 501-400-7700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number12414
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: