Healthcare Provider Details

I. General information

NPI: 1477525137
Provider Name (Legal Business Name): JEFFREY P RIKER DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 09/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

398 FEURA BUSH RD
GLENMONT NY
12077
US

IV. Provider business mailing address

398 FEURA BUSH RD
GLENMONT NY
12077
US

V. Phone/Fax

Practice location:
  • Phone: 518-449-3071
  • Fax: 518-449-3073
Mailing address:
  • Phone: 518-449-3071
  • Fax: 518-449-3073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX7718
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: