Provider Demographics
NPI:1053601286
Name:REYES, RUDY A (DC)
Entity type:Individual
Prefix:DR
First Name:RUDY
Middle Name:A
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 1:7840 MISSION CENTER CT STE 105
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-1320
Mailing Address - Country:US
Mailing Address - Phone:619-574-0554
Mailing Address - Fax:619-574-0559
Practice Address - Street 1:7840 MISSION CENTER CT STE 105
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1320
Practice Address - Country:US
Practice Address - Phone:619-574-0554
Practice Address - Fax:619-574-0559
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-08
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14209111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor