Provider Demographics
NPI:1730371345
Name:REIB, JESPER (DC)
Entity type:Individual
Prefix:DR
First Name:JESPER
Middle Name:
Last Name:REIB
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 1:8300 N HAYDEN RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-2458
Mailing Address - Country:US
Mailing Address - Phone:480-922-2700
Mailing Address - Fax:
Practice Address - Street 1:8300 N HAYDEN RD
Practice Address - Street 2:SUITE 207
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-2458
Practice Address - Country:US
Practice Address - Phone:480-922-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-16
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDC4993111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0237330OtherBSBC
AZDC4993Medicaid
AZDC4993Medicaid
AZDC4993Medicare PIN