Healthcare Provider Details

I. General information

NPI: 1992897920
Provider Name (Legal Business Name): SEAN O. RILEY D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3345 S HARVARD AVE SUITE #101
TULSA OK
74135-1812
US

IV. Provider business mailing address

3345 S HARVARD AVE SUITE #101
TULSA OK
74135-1812
US

V. Phone/Fax

Practice location:
  • Phone: 918-743-3737
  • Fax: 918-728-8801
Mailing address:
  • Phone: 918-743-3737
  • Fax: 918-728-8801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3542
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: