Provider Demographics
NPI:1508194960
Name:DE LOS REYES CHIROPRACTIC
Entity Type:Organization
Organization Name:DE LOS REYES CHIROPRACTIC
Other - Org Name:SIMPLY PRECISE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOMINGO
Authorized Official - Middle Name:J
Authorized Official - Last Name:DE LOS REYES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:504-460-4833
Mailing Address - Street 1:2009 GREEN AVE
Mailing Address - Street 2:
Mailing Address - City:ST. BERNARD
Mailing Address - State:LA
Mailing Address - Zip Code:70085-5614
Mailing Address - Country:US
Mailing Address - Phone:504-460-4833
Mailing Address - Fax:
Practice Address - Street 1:19277 SLEMMER RD
Practice Address - Street 2:STE B
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-5100
Practice Address - Country:US
Practice Address - Phone:504-460-4833
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-24
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1410111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty