Provider Demographics
NPI:1871549659
Name:RISLEY, WILLIAM B JR (DC)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:B
Last Name:RISLEY
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:15207 N 54TH PL
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-2395
Mailing Address - Country:US
Mailing Address - Phone:602-818-2257
Mailing Address - Fax:602-493-0761
Practice Address - Street 1:16620 N 40TH ST
Practice Address - Street 2:BUILDING I, SUITE 2
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-4798
Practice Address - Country:US
Practice Address - Phone:602-493-0004
Practice Address - Fax:602-493-0761
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2017-08-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ5688111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZU70428Medicare UPIN
AZZ23053Medicare ID - Type Unspecified