Healthcare Provider Details

I. General information

NPI: 1275760209
Provider Name (Legal Business Name): REYNOSO-BRUCE CHIROPRACTIC CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2009
Last Update Date: 03/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8873 ADAMS AVE
HUNTINGTON BEACH CA
92646-3301
US

IV. Provider business mailing address

8873 ADAMS AVE
HUNTINGTON BEACH CA
92646-3301
US

V. Phone/Fax

Practice location:
  • Phone: 714-962-8818
  • Fax: 714-962-8819
Mailing address:
  • Phone: 714-962-8818
  • Fax: 714-962-8819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC23961
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC11274
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC11436
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT34304
License Number StateCA

VIII. Authorized Official

Name: DR. ROBERT BRUCE REYNOSO
Title or Position: PRESIDENT
Credential: DC
Phone: 714-962-8818