Provider Demographics
NPI:1699248146
Name:REINHOLT, BRODY WILLIAM (DC)
Entity type:Individual
Prefix:
First Name:BRODY
Middle Name:WILLIAM
Last Name:REINHOLT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 S SCOTT ST
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:IN
Mailing Address - Zip Code:46580-4501
Mailing Address - Country:US
Mailing Address - Phone:574-269-4900
Mailing Address - Fax:
Practice Address - Street 1:308 S SCOTT ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46580-4501
Practice Address - Country:US
Practice Address - Phone:574-269-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-08
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08003072A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor