MEDICARE: DR. DOMINGO JESUS DELOSREYES D.C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	1410	LA

General Provider Information

NPI Number	:	1427259563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOMINGO JESUS DELOSREYES D.C

Provider Business Mailing Address
First Line	:	2113 SERPAS LN
Second Line	:
City	:	SAINT BERNARD
State	:	LA
Zip	:	70085-5822
Country	:	US
Telephone Number	:	504-460-4833
Fax Number	:

Provider Business Practice Location Address
First Line	:	2009 GREEN AVE
Second Line	:
City	:	SAINT BERNARD
State	:	LA
Zip	:	70085-5614
Country	:	US
Telephone Number	:	504-460-4833
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/29/2007
Last Update Date	:	08/19/2009

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