Provider Demographics
NPI:1558586917
Name:REYES CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:REYES CHIROPRACTIC, INC.
Other - Org Name:GOJI, LASER, & SOUND CLINICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:937-339-5998
Mailing Address - Street 1:1385 STONYCREEK RD
Mailing Address - Street 2:SUITE L
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-2561
Mailing Address - Country:US
Mailing Address - Phone:937-339-5998
Mailing Address - Fax:
Practice Address - Street 1:1385 STONYCREEK RD
Practice Address - Street 2:SUITE L
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-2561
Practice Address - Country:US
Practice Address - Phone:937-339-5998
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2833111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSP00292Medicare ID - Type UnspecifiedTROY, OH
OH4037963Medicare ID - Type UnspecifiedTROY, OH