Provider Demographics
NPI:1134981459
Name:REYES, DAVID JEREMIAH (DC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:JEREMIAH
Last Name:REYES
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5747 SADLER CIR APT 2347
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-6619
Mailing Address - Country:US
Mailing Address - Phone:813-363-0274
Mailing Address - Fax:
Practice Address - Street 1:3538 LAKEVIEW PKWY STE 100
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75088-4090
Practice Address - Country:US
Practice Address - Phone:972-325-7578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15876111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor