Provider Demographics
NPI:1972171395
Name:REIFF, LOGAN (DC)
Entity Type:Individual
Prefix:
First Name:LOGAN
Middle Name:
Last Name:REIFF
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 1:4308 N QUINLAN PARK RD STE 200
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78732-6071
Mailing Address - Country:US
Mailing Address - Phone:512-329-5500
Mailing Address - Fax:512-266-6507
Practice Address - Street 1:4308 N QUINLAN PARK RD STE 200
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78732-6071
Practice Address - Country:US
Practice Address - Phone:512-329-5500
Practice Address - Fax:512-266-6507
Is Sole Proprietor?:No
Enumeration Date:2021-06-13
Last Update Date:2021-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14771111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor