Provider Demographics
NPI:1770690299
Name:O'REILLY, CONSTANCE ANN
Entity Type:Individual
Prefix:DR
First Name:CONSTANCE
Middle Name:ANN
Last Name:O'REILLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 E OLIVE AVE
Mailing Address - Street 2:STE 113
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502
Mailing Address - Country:US
Mailing Address - Phone:818-955-9080
Mailing Address - Fax:818-955-9080
Practice Address - Street 1:150 E OLIVE AVE
Practice Address - Street 2:STE 113
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502
Practice Address - Country:US
Practice Address - Phone:818-955-9080
Practice Address - Fax:818-955-9080
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA024831111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor