Provider Demographics
NPI:1679031348
Name:FAKE, RILEY (DC)
Entity type:Individual
Prefix:DR
First Name:RILEY
Middle Name:
Last Name:FAKE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 SPEEN ST STE 201
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701-4174
Mailing Address - Country:US
Mailing Address - Phone:508-620-2848
Mailing Address - Fax:
Practice Address - Street 1:20 SPEEN ST STE 201
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01701-4174
Practice Address - Country:US
Practice Address - Phone:508-620-2848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-12
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3651111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor