Provider Demographics
NPI:1689994626
Name:REILLY, RYAN CHRISTOPHER (DC)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:CHRISTOPHER
Last Name: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 1:4833 MINNETONKA BLVD
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-2214
Mailing Address - Country:US
Mailing Address - Phone:952-913-8786
Mailing Address - Fax:952-922-2335
Practice Address - Street 1:4833 MINNETONKA BLVD
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-2214
Practice Address - Country:US
Practice Address - Phone:952-913-8786
Practice Address - Fax:952-922-2335
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-01
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5398111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor