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Individual

DR. EDWARD REZA JR.

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.C.

Contact information

Practice address
8631 W ARDENE ST, BOISE, ID 83709-2601
(208) 629-1904
(208) 545-1846
Mailing address
8631 W ARDENE ST, BOISE, ID 83709-2601
(208) 629-1904
(208) 545-1846

Taxonomy

Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
8161070
ID
111NR0400X
Rehabilitation Chiropractor
DC28729
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
DC28729
CHIROPRACTIC LICENSE
CA
Enumeration date
03/17/2008
Last updated
10/09/2024
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