Provider Demographics
NPI:1326180621
Name:REISS, MICHAEL TODD (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:TODD
Last Name:REISS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9670 W TROPICANA AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-8291
Mailing Address - Country:US
Mailing Address - Phone:702-227-4848
Mailing Address - Fax:702-227-3344
Practice Address - Street 1:9670 W TROPICANA AVE STE 110
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-8291
Practice Address - Country:US
Practice Address - Phone:702-227-4848
Practice Address - Fax:702-227-3344
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB00774111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV08258Medicare UPIN
NV101979Medicare PIN