Edward Reza Jr., D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

8161070 Issued in ID

Practice address

8631 W Ardene St
Boise, ID 83709-2601

Phone

(208) 629-1904

Fax

(208) 545-1846

NPI assigned

Mar 17, 2008

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Specialty

Chiropractic

Education

Los Angeles College of Chiropractic, 2002

Medicare assignment

May accept Medicare assignment

Group practices

Ideal HealthGroup PAC ID 6800847799, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Ideal Health

  • Chiropractor
  • Boise, ID
  • NPI 1811183023
  Medicare reassignment Care Compare group NPD
• Anthony Fedoryk DC & Edward Reza Jr DC Professional Chiropractic Corpo

  • Chiropractor
  • Newport Beach, CA
  • NPI 1417253410
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1205712000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728432000000",
    "number": "1003087156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8631 W ARDENE ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837092601",
            "telephone_number": "208-629-1904",
            "fax_number": "208-545-1846"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8631 W ARDENE ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837092601",
            "telephone_number": "208-629-1904",
            "fax_number": "208-545-1846"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REZA",
        "first_name": "EDWARD",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-03-17",
        "last_updated": "2024-10-09",
        "certification_date": "2024-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NR0400X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Rehabilitation",
            "state": "CA",
            "license": "DC28729",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "ID",
            "license": "8161070",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHIROPRACTIC LICENSE",
            "identifier": "DC28729",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Garrett Bryan Reynolds, PHARMD
• Megan Ashley Reynolds
• Michael Scott Reynolds, MD
• Terrence J Reynolds, O.D.
• Thomas G Reynolds
• Kevin Paul Rhinehart, MSW
• Abby Lyn Rhoades, FNP-C
• Brandi E Rhoads, LCSW
• Courtney Rhoda, M.S, CF-SLP
• Kristina Deanne Rhodes, CNM

• Chiropractor in Boise, ID
• Providers in Boise, ID by specialty
• Chiropractor in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.