Healthcare Provider Details

I. General information

NPI: 1952669616
Provider Name (Legal Business Name): REILLY CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2012
Last Update Date: 05/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1245 W 5TH AVE
COLUMBUS OH
43212-2507
US

IV. Provider business mailing address

1245 W. 5TH AVENUE
COLUMBUS OH
43212-2507
US

V. Phone/Fax

Practice location:
  • Phone: 614-488-8182
  • Fax: 614-488-9707
Mailing address:
  • Phone: 614-488-8182
  • Fax: 614-488-9707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number1809
License Number StateOH

VIII. Authorized Official

Name: DR. KEVIN PATRICK REILLY
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 614-488-8182