Healthcare Provider Details

I. General information

NPI: 1972171395
Provider Name (Legal Business Name): LOGAN REIFF DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2021
Last Update Date: 06/13/2021
Certification Date: 06/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4308 N QUINLAN PARK RD STE 200
AUSTIN TX
78732-6071
US

IV. Provider business mailing address

4308 N QUINLAN PARK RD STE 200
AUSTIN TX
78732-6071
US

V. Phone/Fax

Practice location:
  • Phone: 512-329-5500
  • Fax: 512-266-6507
Mailing address:
  • Phone: 512-329-5500
  • Fax: 512-266-6507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number14771
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: