Provider Demographics
NPI:1235452707
Name:PATHAK, REENA (DC)
Entity Type:Individual
Prefix:DR
First Name:REENA
Middle Name:
Last Name:PATHAK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28780 JOHN R ROAD
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071
Mailing Address - Country:US
Mailing Address - Phone:248-548-1110
Mailing Address - Fax:248-548-2702
Practice Address - Street 1:28780 JOHN R RD
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-2800
Practice Address - Country:US
Practice Address - Phone:248-548-1110
Practice Address - Fax:248-548-2702
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009652111N00000X
IL038.011603111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor