Provider Demographics
NPI:1396703922
Name:REILLY, CHRISTOPHER (DC)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:
Last Name:REILLY
Suffix:
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 1:1559 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HELLERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18055
Mailing Address - Country:US
Mailing Address - Phone:610-838-3252
Mailing Address - Fax:610-838-3253
Practice Address - Street 1:1559 MAIN ST
Practice Address - Street 2:
Practice Address - City:HELLERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18055
Practice Address - Country:US
Practice Address - Phone:610-838-3252
Practice Address - Fax:610-838-3253
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007213L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
RE020083Medicare ID - Type Unspecified
U76748Medicare UPIN