Healthcare Provider Details

I. General information

NPI: 1740727676
Provider Name (Legal Business Name): REYES FAMILY CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2017
Last Update Date: 01/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1890 SAM RITTENBERG BLVD STE 223
CHARLESTON SC
29407-4801
US

IV. Provider business mailing address

1890 SAM RITTENBERG BLVD STE 223
CHARLESTON SC
29407-4801
US

V. Phone/Fax

Practice location:
  • Phone: 843-225-8414
  • Fax: 843-282-7784
Mailing address:
  • Phone: 843-225-8414
  • Fax: 843-282-7784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4110
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number4110
License Number StateSC

VIII. Authorized Official

Name: MRS. LAURA REYES
Title or Position: OPERATIONS
Credential:
Phone: 843-225-8414