Provider Demographics
NPI:1083703664
Name:REILLY, PAUL EDWARD (ND, LAC)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:EDWARD
Last Name:REILLY
Suffix:
Gender:M
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 PACIFIC E HWY
Mailing Address - Street 2:
Mailing Address - City:FIFE
Mailing Address - State:WA
Mailing Address - Zip Code:98424-1148
Mailing Address - Country:US
Mailing Address - Phone:253-382-6300
Mailing Address - Fax:253-382-6301
Practice Address - Street 1:3700 PACIFIC HWY E
Practice Address - Street 2:SUITE 100
Practice Address - City:FIFE
Practice Address - State:WA
Practice Address - Zip Code:98424-1148
Practice Address - Country:US
Practice Address - Phone:253-382-6300
Practice Address - Fax:253-382-6301
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist