Healthcare Provider Details

I. General information

NPI: 1124956198
Provider Name (Legal Business Name): LOGAN RILEY SRNA DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 SKINNER BLVD APT D
DUNEDIN FL
34698-4995
US

IV. Provider business mailing address

424 SKINNER BLVD APT D
DUNEDIN FL
34698-4995
US

V. Phone/Fax

Practice location:
  • Phone: 727-330-6718
  • Fax: 727-380-9178
Mailing address:
  • Phone: 727-330-6718
  • Fax: 727-380-9178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number15949
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: