Provider Demographics
NPI:1770662652
Name:REYES, JUAN A (DC)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:A
Last Name: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 1:936 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-4923
Mailing Address - Country:US
Mailing Address - Phone:203-787-9554
Mailing Address - Fax:203-787-0554
Practice Address - Street 1:936 GRAND AVE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-4923
Practice Address - Country:US
Practice Address - Phone:203-787-9554
Practice Address - Fax:203-787-0554
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001660111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor