Healthcare Provider Details

I. General information

NPI: 1518101328
Provider Name (Legal Business Name): CHIROMARK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2009
Last Update Date: 10/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 COMMERCE ST STE B
GLASTONBURY CT
06033-4802
US

IV. Provider business mailing address

10 COMMERCE ST STE B
GLASTONBURY CT
06033-4802
US

V. Phone/Fax

Practice location:
  • Phone: 860-430-9116
  • Fax: 860-430-9108
Mailing address:
  • Phone: 860-430-9116
  • Fax: 860-430-9108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCT01479
License Number StateCT

VIII. Authorized Official

Name: DR. CHRISTIAN CHARLES REILLY
Title or Position: CO-OWNER
Credential: D.C.
Phone: 860-430-9116