Provider Demographics
NPI:1477585065
Name:REYZELMAN, VICTORIA (DC)
Entity Type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:
Last Name:REYZELMAN
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 1:4245 LILAC RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94582-5019
Mailing Address - Country:US
Mailing Address - Phone:925-735-3203
Mailing Address - Fax:
Practice Address - Street 1:220 MONTGOMERY ST STE 305
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94104-3444
Practice Address - Country:US
Practice Address - Phone:415-677-9900
Practice Address - Fax:415-358-5803
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28017111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU98236Medicare UPIN
CADC0280170Medicare ID - Type Unspecified