Healthcare Provider Details

I. General information

NPI: 1700641396
Provider Name (Legal Business Name): RILEY EDLING DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2024
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11230 86TH AVE N
MAPLE GROVE MN
55369-4510
US

IV. Provider business mailing address

20 2ND ST NE UNIT P1108
MINNEAPOLIS MN
55413-2379
US

V. Phone/Fax

Practice location:
  • Phone: 612-208-6127
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number7194
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: