Provider Demographics
NPI:1013910447
Name:REYES, JOSE SANTANA (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:SANTANA
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 1:1999 EDISON HWY
Mailing Address - Street 2:SUITES 2,4, 6
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93305-5554
Mailing Address - Country:US
Mailing Address - Phone:661-861-9266
Mailing Address - Fax:661-861-9222
Practice Address - Street 1:1999 EDISON HWY
Practice Address - Street 2:SUITES 2,4, 6
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93305-5554
Practice Address - Country:US
Practice Address - Phone:661-861-9266
Practice Address - Fax:661-861-9222
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28154111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV05811Medicare UPIN