Provider Demographics
NPI:1568640399
Name:REYNOSO, ROBERT BRUCE (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:BRUCE
Last Name:REYNOSO
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 1:8941 ADAMS AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-3330
Mailing Address - Country:US
Mailing Address - Phone:714-962-8818
Mailing Address - Fax:714-962-8819
Practice Address - Street 1:8941 ADAMS AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92646-3330
Practice Address - Country:US
Practice Address - Phone:714-962-8818
Practice Address - Fax:714-962-8819
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-04
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23961111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor