=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073460952
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RILEY CHIROPRACTIC PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/11/2026
-----------------------------------------------------
Last Update Date | 03/11/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 211 S PROSPECT RD STE 5
-----------------------------------------------------
City | BLOOMINGTON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61704-4907
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 309-265-5173
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2708 E WASHINGTON ST
-----------------------------------------------------
City | BLOOMINGTON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61704-4648
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 309-265-5173
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINIC DIRECTOR
-----------------------------------------------------
Name | MORGAN RILEY
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 309-265-5173
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------