Healthcare Provider Details

I. General information

NPI: 1194736751
Provider Name (Legal Business Name): JOHN R RIKER DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

398 FEURA BUSH RD SUITE 2
GLENMONT NY
12077-2954
US

IV. Provider business mailing address

398 FEURA BUSH RD SUITE 2
GLENMONT NY
12077-2954
US

V. Phone/Fax

Practice location:
  • Phone: 518-618-5362
  • Fax: 518-449-3073
Mailing address:
  • Phone: 518-618-5362
  • Fax: 518-449-3073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX005277-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: