Provider Demographics
NPI:1841204351
Name:REILLY, WILLIAM L JR (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:L
Last Name:REILLY
Suffix:JR
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 1:727 EAST LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:MYERSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17067
Mailing Address - Country:US
Mailing Address - Phone:717-866-4423
Mailing Address - Fax:717-866-8534
Practice Address - Street 1:727 EAST LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:MYERSTOWN
Practice Address - State:PA
Practice Address - Zip Code:17067
Practice Address - Country:US
Practice Address - Phone:717-866-4423
Practice Address - Fax:717-866-8534
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2011-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003042L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
RE194754OtherHIGHMARK BLUE SHIELD
129147OtherHEALTH ASSURANCE
838870OtherAETNAL HMO
0039940000OtherPERSONAL CHOINCE IND ID
129147OtherHEALTH AMERICA
350039393OtherRAILROAD MEDICARE
5960056OtherAETNA
02647800OtherCAPITAL BLUE CROSS
2454670000OtherPERSONAL CHOICE GROUP ID
3559492OtherCIGNA
3000257OtherKEYSTONE
3000257OtherKEYSTONE
2454670000OtherPERSONAL CHOICE GROUP ID