Healthcare Provider Details

I. General information

NPI: 1699942805
Provider Name (Legal Business Name): S. RILEY CHIROPRACTIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2008
Last Update Date: 11/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 SAN AUGUSTINE ST
CENTER TX
75935-3953
US

IV. Provider business mailing address

201 SAN AUGUSTINE ST
CENTER TX
75935-3953
US

V. Phone/Fax

Practice location:
  • Phone: 936-598-5200
  • Fax: 936-591-0505
Mailing address:
  • Phone: 936-598-5200
  • Fax: 936-591-0505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number9199
License Number StateTX

VIII. Authorized Official

Name: DR. SHAWN G. RILEY
Title or Position: OWNER/PROVIDER
Credential: DC
Phone: 936-598-5200