Healthcare Provider Details

I. General information

NPI: 1184060295
Provider Name (Legal Business Name): ANTHONY MICHAEL RIES DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2013
Last Update Date: 01/05/2021
Certification Date: 01/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2125 N DAMEN AVE
CHICAGO IL
60647-9613
US

IV. Provider business mailing address

1009 N RIVERWALK ST
CHICAGO IL
60610-7398
US

V. Phone/Fax

Practice location:
  • Phone: 563-564-9105
  • Fax:
Mailing address:
  • Phone: 563-564-9105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038011970
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number038.011970
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: