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NPI Code Detail

MEDICARE: DR. CAMILLE CATHERINE REAGAN DC

MEDICARE: DR. CAMILLE CATHERINE REAGAN DC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111NS0005XSports Physician Chiropractor9065TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11194908210OTHERTXGROUP NPI
20016QUOTHERTXBCBS GROUP NUMBER
38AT940OTHERBCBS PROVIDER NUMBER

General Provider Information

NPI Number : 1215113451
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CAMILLE CATHERINE REAGAN DC
Provider Business Mailing Address
First Line : 13396 PRESTON RD
Second Line :
City : DALLAS
State : TX
Zip : 75240-5208
Country : US
Telephone Number : 972-503-7272
Fax Number : 413-280-8766
Provider Business Practice Location Address
First Line : 13396 PRESTON RD
Second Line :
City : DALLAS
State : TX
Zip : 75240-5208
Country : US
Telephone Number : 972-503-7272
Fax Number : 413-280-8766
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/17/2008
Last Update Date : 01/17/2008

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Directions to “ DR. CAMILLE CATHERINE REAGAN DC” Practice Location

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