Healthcare Provider Details

I. General information

NPI: 1104762319
Provider Name (Legal Business Name): CHAD ERIC RILEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10805 N MACARTHUR BLVD
OKLAHOMA CITY OK
73162-6901
US

IV. Provider business mailing address

1644 E HIGHWAY 66 TRLR 61
EL RENO OK
73036-5767
US

V. Phone/Fax

Practice location:
  • Phone: 405-368-9101
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: