Provider Demographics
NPI:1386614485
Name:REISING, ANITA M (DC)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:M
Last Name:REISING
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 1:315 N MAIN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-1615
Mailing Address - Country:US
Mailing Address - Phone:618-656-0178
Mailing Address - Fax:
Practice Address - Street 1:315 N MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025-1615
Practice Address - Country:US
Practice Address - Phone:618-656-0178
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
197486OtherH/L
IL06082085OtherBL CROSS
IL06082085OtherBL CROSS