Provider Demographics
NPI:1124053905
Name:REYES, DANNIELL JESUS (DC, CCSP, DACRB)
Entity type:Individual
Prefix:DR
First Name:DANNIELL
Middle Name:JESUS
Last Name:REYES
Suffix:
Gender:M
Credentials:DC, CCSP, DACRB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 E 88TH AVE APT 216
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80229-4478
Mailing Address - Country:US
Mailing Address - Phone:610-349-6679
Mailing Address - Fax:
Practice Address - Street 1:8155 W 94TH AVE
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80021-4515
Practice Address - Country:US
Practice Address - Phone:303-423-4610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-006207-L111NR0400X
CO0008197111NR0400X
PADC-OO6207-L111NS0005X
PADC006207L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA265170001OtherKEYSTONE EAST
PA7957156OtherAETNA
PA02754900OtherASHN GROUP
PA2141296000OtherPERSONAL CHOICE GROUP
PA2141296000OtherKEYSTONE EAST GROUP
PA3000378OtherKEYSTONE CENTRAL
PA1146297OtherAMERIHEALTH MERCY
PA1445656OtherBLUE CARD /BS
PA233046549OtherUNITED HEALTH CARE
PA506314OtherAMERIHEALTH ADMIN.
PA026517000OtherPERSONAL CHOICE
PA02754900OtherKEYSTONE CENTRAL GROUP
PA01877901OtherASHN IND.
PA0265170000OtherIND. BC/BS
PA1528871OtherGATEWAY
PA2141296000OtherIND. BC/BS GROUP
PA233046549OtherUNITED HEALTH CARE