Provider Demographics
NPI:1295944361
Name:REYNA CHIROPRACTIC CENTER INC
Entity type:Organization
Organization Name:REYNA CHIROPRACTIC CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:R
Authorized Official - Last Name:REYNA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:305-388-5348
Mailing Address - Street 1:10201 HAMMOCKS BLVD
Mailing Address - Street 2:SUITE 152
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-4712
Mailing Address - Country:US
Mailing Address - Phone:305-388-5348
Mailing Address - Fax:305-385-8557
Practice Address - Street 1:10201 HAMMOCKS BLVD
Practice Address - Street 2:SUITE 152
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-4712
Practice Address - Country:US
Practice Address - Phone:305-388-5348
Practice Address - Fax:305-385-8557
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REYNA CHIROPRACTIC CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-22
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7491111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3814147032Medicaid