Provider Demographics
NPI:1174260749
Name:ENOS, REILLY D (DC)
Entity Type:Individual
Prefix:DR
First Name:REILLY
Middle Name:D
Last Name:ENOS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8690 W PAHS RD
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-7666
Mailing Address - Country:US
Mailing Address - Phone:192-872-5151
Mailing Address - Fax:
Practice Address - Street 1:8690 W PAHS RD
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-7666
Practice Address - Country:US
Practice Address - Phone:219-872-5151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-16
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08003302A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor