Provider Demographics
NPI:1427192558
Name:FLORES, REESON EARL (DC)
Entity Type:Individual
Prefix:DR
First Name:REESON
Middle Name:EARL
Last Name:FLORES
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 1:310 E BROADWAY STE 102
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1745
Mailing Address - Country:US
Mailing Address - Phone:502-600-0858
Mailing Address - Fax:502-953-0862
Practice Address - Street 1:310 E BROADWAY STE 102
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1745
Practice Address - Country:US
Practice Address - Phone:502-600-0858
Practice Address - Fax:502-953-0862
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY248769111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7465516OtherAETNA