Provider Demographics
NPI:1518037498
Name:REIS, BRIAN JEFFREY (DC)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:JEFFREY
Last Name:REIS
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 1:700 EDGEWATER BLVD
Mailing Address - Street 2:# 107
Mailing Address - City:FOSTER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94404-2873
Mailing Address - Country:US
Mailing Address - Phone:650-465-2286
Mailing Address - Fax:650-393-4484
Practice Address - Street 1:700 EDGEWATER BLVD
Practice Address - Street 2:#107
Practice Address - City:FOSTER CITY
Practice Address - State:CA
Practice Address - Zip Code:94404-2873
Practice Address - Country:US
Practice Address - Phone:650-465-2286
Practice Address - Fax:650-393-4484
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15360111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADE0153600Medicare ID - Type Unspecified