Provider Demographics
NPI:1750628954
Name:DE LOS REYES, ANGEL MANUEL (DC)
Entity Type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:MANUEL
Last Name:DE LOS REYES
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 1:953 N SEMORAN BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32807-3528
Mailing Address - Country:US
Mailing Address - Phone:407-282-3615
Mailing Address - Fax:
Practice Address - Street 1:953 N SEMORAN BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-3528
Practice Address - Country:US
Practice Address - Phone:407-282-3615
Practice Address - Fax:407-275-7221
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-08
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10807111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor