Provider Demographics
NPI:1447492871
Name:REID A BRECKE DC PROF CORP
Entity type:Organization
Organization Name:REID A BRECKE DC PROF CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESEIDENT
Authorized Official - Prefix:
Authorized Official - First Name:REID
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRECKE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:775-827-2323
Mailing Address - Street 1:2215 GREEN VISTA DR STE 304
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-8508
Mailing Address - Country:US
Mailing Address - Phone:775-827-2323
Mailing Address - Fax:775-827-0305
Practice Address - Street 1:2215 GREEN VISTA DR STE 304
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-8508
Practice Address - Country:US
Practice Address - Phone:775-827-2323
Practice Address - Fax:775-827-0305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-31
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB00286261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center