Provider Demographics
NPI:1720461072
Name:REISINGER, BRYAN J (MTCM, CMT, LAC)
Entity Type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:J
Last Name:REISINGER
Suffix:
Gender:M
Credentials:MTCM, CMT, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6055 MERIDIAN AVE
Mailing Address - Street 2:SUITE 30
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95120-2750
Mailing Address - Country:US
Mailing Address - Phone:408-766-1811
Mailing Address - Fax:408-550-7112
Practice Address - Street 1:6055 MERIDIAN AVE
Practice Address - Street 2:SUITE 30
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95120-2750
Practice Address - Country:US
Practice Address - Phone:408-766-1811
Practice Address - Fax:408-550-7112
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-06
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC16628171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist