Provider Demographics
NPI:1275760209
Name:REYNOSO-BRUCE CHIROPRACTIC CORP
Entity Type:Organization
Organization Name:REYNOSO-BRUCE CHIROPRACTIC CORP
Other - Org Name:HEALTH PRO WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:REYNOSO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:714-962-8818
Mailing Address - Street 1:8873 ADAMS AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-3301
Mailing Address - Country:US
Mailing Address - Phone:714-962-8818
Mailing Address - Fax:714-962-8819
Practice Address - Street 1:8873 ADAMS AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92646-3301
Practice Address - Country:US
Practice Address - Phone:714-962-8818
Practice Address - Fax:714-962-8819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-17
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23961111N00000X
CAAC11274171100000X
CAAC11436171100000X
CAPT34304225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1407030117OtherNPI NUMBER
CA1316285588OtherNPI NUMBER
CA1568640399OtherNPI NUMBER
CA1215183660OtherNPI