Provider Demographics
NPI:1568769305
Name:REILAND, JAMES ELMER JR (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ELMER
Last Name:REILAND
Suffix:JR
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 1:1100 S MAIN ST
Mailing Address - Street 2:STE. D
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-7531
Mailing Address - Country:US
Mailing Address - Phone:817-905-5009
Mailing Address - Fax:817-488-9054
Practice Address - Street 1:1100 S MAIN ST
Practice Address - Street 2:STE. D
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-7531
Practice Address - Country:US
Practice Address - Phone:817-905-5009
Practice Address - Fax:817-488-9054
Is Sole Proprietor?:No
Enumeration Date:2011-02-14
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11491111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor