Provider Demographics
NPI:1316079643
Name:REICHERT FAMILY CHIROPRACTIC LLC
Entity type:Organization
Organization Name:REICHERT FAMILY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:REICHERT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:614-866-7776
Mailing Address - Street 1:6502 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-2380
Mailing Address - Country:US
Mailing Address - Phone:614-866-7776
Mailing Address - Fax:614-866-7760
Practice Address - Street 1:6502 E MAIN ST
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-2380
Practice Address - Country:US
Practice Address - Phone:614-866-7776
Practice Address - Fax:614-866-7760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4374111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0398163Medicaid
OH9359761Medicare ID - Type UnspecifiedMC GROUP
OH0398163Medicaid