Provider Demographics
NPI:1740223999
Name:REILLY, DOUGLAS (DC)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:
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:PO BOX 1070
Mailing Address - Street 2:5891EASTON ROAD
Mailing Address - City:PLUMSTEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18949-1070
Mailing Address - Country:US
Mailing Address - Phone:215-766-4804
Mailing Address - Fax:215-766-9965
Practice Address - Street 1:5891 EASTON ROAD
Practice Address - Street 2:
Practice Address - City:PLUMSTEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:18949-1070
Practice Address - Country:US
Practice Address - Phone:215-766-4804
Practice Address - Fax:215-766-9965
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC8608111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA053944Medicare ID - Type Unspecified
PAU88376Medicare UPIN