MEDICARE: S. RILEY CHIROPRACTIC PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	9199	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	608231	OTHER	TX	BCBSTX

General Provider Information

NPI Number	:	1699942805
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	S. RILEY CHIROPRACTIC PLLC

Provider Business Mailing Address
First Line	:	201 SAN AUGUSTINE ST
Second Line	:
City	:	CENTER
State	:	TX
Zip	:	75935-3953
Country	:	US
Telephone Number	:	936-598-5200
Fax Number	:	936-591-0505

Provider Business Practice Location Address
First Line	:	201 SAN AUGUSTINE ST
Second Line	:
City	:	CENTER
State	:	TX
Zip	:	75935-3953
Country	:	US
Telephone Number	:	936-598-5200
Fax Number	:	936-591-0505

Authorized Official
Title or Position	:	OWNER/PROVIDER
Name	:	DR. SHAWN G. RILEY
Credential	:	DC
Telephone Number	:	936-598-5200

Provider Enumeration Date	:	05/15/2008
Last Update Date	:	11/06/2013

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