Provider Demographics
NPI:1689029670
Name:PRODIUS, INC.
Entity Type:Organization
Organization Name:PRODIUS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:REARDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-867-7883
Mailing Address - Street 1:419 MAIN ST # 312
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-5199
Mailing Address - Country:US
Mailing Address - Phone:714-867-7883
Mailing Address - Fax:844-228-9778
Practice Address - Street 1:16561 BOLSA CHICA ST STE 106
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92649-3574
Practice Address - Country:US
Practice Address - Phone:714-377-4313
Practice Address - Fax:844-228-9778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-27
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16989111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty