Healthcare Provider Details

I. General information

NPI: 1942085501
Provider Name (Legal Business Name): CISCO CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2023
Last Update Date: 08/30/2023
Certification Date: 08/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1498 I 20 W
CISCO TX
76437-3672
US

IV. Provider business mailing address

1700 CONRAD HILTON BLVD
CISCO TX
76437-4857
US

V. Phone/Fax

Practice location:
  • Phone: 254-442-7643
  • Fax:
Mailing address:
  • Phone: 254-784-3309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. JONATHON HEATH REICH
Title or Position: OWNER/DOCTOR OF CHIROPRACTIC
Credential: DC
Phone: 254-784-3309