Healthcare Provider Details

I. General information

NPI: 1396703922
Provider Name (Legal Business Name): CHRISTOPHER REILLY DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 02/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1559 MAIN ST
HELLERTOWN PA
18055
US

IV. Provider business mailing address

1559 MAIN ST
HELLERTOWN PA
18055
US

V. Phone/Fax

Practice location:
  • Phone: 610-838-3252
  • Fax: 610-838-3253
Mailing address:
  • Phone: 610-838-3252
  • Fax: 610-838-3253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC007213L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: