Provider Demographics
NPI:1689483489
Name:REYES, NICHOLAS (DC)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
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 1:6110 MCFARLAND STATION DR UNIT 301
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-6806
Mailing Address - Country:US
Mailing Address - Phone:470-839-8686
Mailing Address - Fax:
Practice Address - Street 1:6110 MCFARLAND STATION DR UNIT 301
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-6806
Practice Address - Country:US
Practice Address - Phone:470-839-8686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO011313111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician