Provider Demographics
NPI:1518073022
Name:ADORABLE, REYNARDO (DC)
Entity Type:Individual
Prefix:
First Name:REYNARDO
Middle Name:
Last Name:ADORABLE
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 1:6029 BELT LINE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-9137
Mailing Address - Country:US
Mailing Address - Phone:972-392-7008
Mailing Address - Fax:972-392-1171
Practice Address - Street 1:6029 BELT LINE RD STE 100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254-9137
Practice Address - Country:US
Practice Address - Phone:972-392-7008
Practice Address - Fax:972-392-1171
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC4635111N00000X, 171100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered171100000XOther Service ProvidersAcupuncturist
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8J3270OtherBLUE CROSS BLUE SHIELD
TX601868Medicare ID - Type Unspecified
TX8J3270OtherBLUE CROSS BLUE SHIELD