Provider Demographics
NPI:1396841664
Name:REIF, SHAD (DC)
Entity Type:Individual
Prefix:
First Name:SHAD
Middle Name:
Last Name:REIF
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 1:114 S JACKSON AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-3923
Mailing Address - Country:US
Mailing Address - Phone:972-429-8228
Mailing Address - Fax:972-429-8229
Practice Address - Street 1:114 S JACKSON AVE STE 200
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-3923
Practice Address - Country:US
Practice Address - Phone:972-429-4677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR5938111N00000X
TX10581111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCHR5938OtherCOLORADO STATE LICENSE
TX10581OtherSTATE OF TEXAS
TX10581OtherSTATE OF TEXAS