Provider Demographics
NPI:1275665028
Name:O'REILLY, THOMAS K (DC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:K
Last Name:O'REILLY
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:PO BOX 2
Mailing Address - Street 2:
Mailing Address - City:BLACKDUCK
Mailing Address - State:MN
Mailing Address - Zip Code:56630-0002
Mailing Address - Country:US
Mailing Address - Phone:218-835-2273
Mailing Address - Fax:218-835-2273
Practice Address - Street 1:80 SUMMIT AVE W
Practice Address - Street 2:
Practice Address - City:BLACKDUCK
Practice Address - State:MN
Practice Address - Zip Code:56630
Practice Address - Country:US
Practice Address - Phone:218-835-2273
Practice Address - Fax:218-835-2273
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2507111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN261228300Medicaid
MN350001444Medicare ID - Type Unspecified
MNT65962Medicare UPIN