Provider Demographics
NPI:1780736967
Name:REILLY, JOSEPH ARTHUR JR (DC)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:ARTHUR
Last Name:REILLY
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:17707 HIDDEN FOREST DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-8765
Mailing Address - Country:US
Mailing Address - Phone:713-524-0966
Mailing Address - Fax:713-524-1204
Practice Address - Street 1:3415 LOUISIANA ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-9523
Practice Address - Country:US
Practice Address - Phone:713-524-0966
Practice Address - Fax:713-524-1204
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX601197Medicare ID - Type UnspecifiedPROVIDER NUMBER
TX2900Medicare UPIN