Provider Demographics
NPI:1154619252
Name:REIFF, NICHOLAS DONALD (DC)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:DONALD
Last Name:REIFF
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 1:13661 HAZEL ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92844-2637
Mailing Address - Country:US
Mailing Address - Phone:562-999-2383
Mailing Address - Fax:
Practice Address - Street 1:401 E OCEAN BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-4965
Practice Address - Country:US
Practice Address - Phone:562-999-2383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-11
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32017111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor