Provider Demographics
NPI:1730128380
Name:REILLY, ANNE L (DC)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:L
Last Name:REILLY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 11TH ST
Mailing Address - Street 2:
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221
Mailing Address - Country:US
Mailing Address - Phone:360-293-6313
Mailing Address - Fax:360-873-8769
Practice Address - Street 1:1209 11TH ST
Practice Address - Street 2:
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221
Practice Address - Country:US
Practice Address - Phone:360-293-6313
Practice Address - Fax:360-873-8769
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2503111N00000X
SC1448111N00000X
MECR836111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA20878OtherUPIN