Provider Demographics
NPI:1851458004
Name:REILEY CHIROPRACTIC A PROFESSIONAL CHIROPRACTIC CORPORATION
Entity Type:Organization
Organization Name:REILEY CHIROPRACTIC A PROFESSIONAL CHIROPRACTIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:REILEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:949-448-9088
Mailing Address - Street 1:27131 ALISO CREEK RD
Mailing Address - Street 2:#105
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-3363
Mailing Address - Country:US
Mailing Address - Phone:949-448-9088
Mailing Address - Fax:949-448-9096
Practice Address - Street 1:27131 ALISO CREEK RD
Practice Address - Street 2:#105
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-3363
Practice Address - Country:US
Practice Address - Phone:949-448-9088
Practice Address - Fax:949-448-9096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24205111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC24205Medicare PIN