Provider Demographics
NPI:1154290617
Name:REIDT, ELLEN (DC)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:REIDT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16100 CHESTERFIELD PKWY W
Mailing Address - Street 2:SUITE 175
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017
Mailing Address - Country:US
Mailing Address - Phone:314-735-0780
Mailing Address - Fax:314-735-1625
Practice Address - Street 1:16100 CHESTERFIELD PARKWAY W
Practice Address - Street 2:SUITE 175
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017
Practice Address - Country:US
Practice Address - Phone:314-735-0780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-03
Last Update Date:2025-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2025024868111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner