Provider Demographics
NPI:1255303657
Name:REILLY, EDWARD G (DC)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:G
Last Name:REILLY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 FAIRVIEW HILLS DR
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:NC
Mailing Address - Zip Code:28730-9777
Mailing Address - Country:US
Mailing Address - Phone:828-628-7800
Mailing Address - Fax:828-628-4328
Practice Address - Street 1:2 FAIRVIEW HILLS DR
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:NC
Practice Address - Zip Code:28730-9777
Practice Address - Country:US
Practice Address - Phone:828-628-7800
Practice Address - Fax:828-628-4328
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2407111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890832JMedicaid
NC2452139Medicare ID - Type Unspecified
NCU70092Medicare UPIN