Provider Demographics
NPI:1932244241
Name:REYES, ALBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:
Last Name:REYES
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1890 SAM RITTENBERG BLVD
Mailing Address - Street 2:SUITE 223
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-4801
Mailing Address - Country:US
Mailing Address - Phone:843-225-8414
Mailing Address - Fax:843-282-7784
Practice Address - Street 1:1890 SAM RITTENBERG BLVD
Practice Address - Street 2:SUITE 223
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-4801
Practice Address - Country:US
Practice Address - Phone:843-225-8414
Practice Address - Fax:843-282-7784
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4110111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician