Provider Demographics
NPI:1154749547
Name:REIS, ERIK WILLIAM (DC)
Entity type:Individual
Prefix:MR
First Name:ERIK
Middle Name:WILLIAM
Last Name:REIS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4035 MERCANTILE DR
Mailing Address - Street 2:112
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-2546
Mailing Address - Country:US
Mailing Address - Phone:503-850-4526
Mailing Address - Fax:503-908-1555
Practice Address - Street 1:4035 MERCANTILE DR
Practice Address - Street 2:112
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-2546
Practice Address - Country:US
Practice Address - Phone:503-850-4526
Practice Address - Fax:503-908-1555
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-02
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OR5557111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology