Healthcare Provider Details

I. General information

NPI: 1265401541
Provider Name (Legal Business Name): JACK DAVID SCHILLEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 10/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1255 LIBERTY STREET
REDDING CA
96001-0814
US

IV. Provider business mailing address

PO BOX 991950
REDDING CA
96099-1950
US

V. Phone/Fax

Practice location:
  • Phone: 530-246-2467
  • Fax: 530-242-9460
Mailing address:
  • Phone: 530-246-2467
  • Fax: 530-242-9460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA91728
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: