Provider Demographics
NPI:1447477914
Name:THALJI, REIF (DC)
Entity type:Individual
Prefix:DR
First Name:REIF
Middle Name:
Last Name:THALJI
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 1:14555 SKINNER RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-1734
Mailing Address - Country:US
Mailing Address - Phone:281-758-2800
Mailing Address - Fax:
Practice Address - Street 1:14555 SKINNER RD
Practice Address - Street 2:SUITE A
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-1734
Practice Address - Country:US
Practice Address - Phone:281-758-2800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9644111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX261166518OtherEIN
TX8G1924Medicare ID - Type Unspecified