Provider Demographics
NPI:1043338767
Name:DOUGLAS L. REICH CHIROPRACTIC WELLNESS CENTER, INC.
Entity Type:Organization
Organization Name:DOUGLAS L. REICH CHIROPRACTIC WELLNESS CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:LLOYD
Authorized Official - Last Name:REICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-736-0286
Mailing Address - Street 1:338 VIA VERA CRUZ STE 120
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-2647
Mailing Address - Country:US
Mailing Address - Phone:760-736-0286
Mailing Address - Fax:760-736-3113
Practice Address - Street 1:338 VIA VERA CRUZ STE 120
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-2647
Practice Address - Country:US
Practice Address - Phone:760-736-0286
Practice Address - Fax:760-736-3113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13373111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB261698Medicaid