MEDICARE: DR. SIMON REYES GO 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	DC20602	CA

General Provider Information

NPI Number	:	1619047602
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SIMON REYES GO D.C.

Provider Business Mailing Address
First Line	:	14623 HAWTHORNE BLVD
Second Line	:	SUITE 206
City	:	LAWNDALE
State	:	CA
Zip	:	90260-1581
Country	:	US
Telephone Number	:	310-675-8803
Fax Number	:	310-370-7380

Provider Business Practice Location Address
First Line	:	14623 HAWTHORNE BLVD
Second Line	:	SUITE 206
City	:	LAWNDALE
State	:	CA
Zip	:	90260-1581
Country	:	US
Telephone Number	:	310-675-8803
Fax Number	:	310-370-7380

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

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. SIMON REYES GO D.C.” Practice Location

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