Provider Demographics
NPI:1477755593
Name:BRECKE, REID ALAN (DC)
Entity Type:Individual
Prefix:DR
First Name:REID
Middle Name:ALAN
Last Name:BRECKE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:REID
Other - Middle Name:ALAN
Other - Last Name:BRECKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:2215 GREEN VISTA DRIVE
Mailing Address - Street 2:STE. 304
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431
Mailing Address - Country:US
Mailing Address - Phone:775-827-2323
Mailing Address - Fax:775-827-0305
Practice Address - Street 1:2215 GREEN VISTA DRIVE
Practice Address - Street 2:STE. 304
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431
Practice Address - Country:US
Practice Address - Phone:775-827-2323
Practice Address - Fax:775-827-0305
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB00286111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor