Provider Demographics
NPI:1952669616
Name:REILLY CHIROPRACTIC
Entity Type:Organization
Organization Name:REILLY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:REILLY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:614-488-8182
Mailing Address - Street 1:1245 W. 5TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43212-2507
Mailing Address - Country:US
Mailing Address - Phone:614-488-8182
Mailing Address - Fax:614-488-9707
Practice Address - Street 1:1245 W 5TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43212-2507
Practice Address - Country:US
Practice Address - Phone:614-488-8182
Practice Address - Fax:614-488-9707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-01
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1809111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHU39660Medicare UPIN