Healthcare Provider Details

I. General information

NPI: 1316153026
Provider Name (Legal Business Name): KEVIN FRANCIS REICHLIN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2439 BROADWAY ST
BOULDER CO
80304-4108
US

IV. Provider business mailing address

2439 BROADWAY ST
BOULDER CO
80304-4108
US

V. Phone/Fax

Practice location:
  • Phone: 303-443-1553
  • Fax: 303-443-8069
Mailing address:
  • Phone: 303-443-1553
  • Fax: 303-443-8069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number5609
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: