Provider Demographics
NPI:1750327425
Name:REILLY, DANIEL J (DC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:J
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 1:777 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45150-1786
Mailing Address - Country:US
Mailing Address - Phone:513-831-3800
Mailing Address - Fax:513-831-3857
Practice Address - Street 1:777 MAIN ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:OH
Practice Address - Zip Code:45150-1786
Practice Address - Country:US
Practice Address - Phone:513-831-3800
Practice Address - Fax:513-831-3857
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1521111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0826039Medicaid
OH0826039Medicaid
OHU17039Medicare UPIN