Provider Demographics
NPI:1316194061
Name:REILEY, JAMES
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:REILEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27131 ALISO CREEK RD
Mailing Address - Street 2:#105
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-3363
Mailing Address - Country:US
Mailing Address - Phone:949-448-9088
Mailing Address - Fax:949-448-9096
Practice Address - Street 1:27131 ALISO CREEK RD
Practice Address - Street 2:#105
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-3363
Practice Address - Country:US
Practice Address - Phone:949-448-9088
Practice Address - Fax:949-448-9096
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-25
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD.C. 24205111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC24205OtherD.C. LISCENCE NUMBER