Provider Demographics
NPI:1699942680
Name:REITER CHIROPRACTIC PC
Entity type:Organization
Organization Name:REITER CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:REITER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-363-1163
Mailing Address - Street 1:5415 BULL VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-7410
Mailing Address - Country:US
Mailing Address - Phone:815-363-1163
Mailing Address - Fax:
Practice Address - Street 1:5415 BULL VALLEY RD
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-7410
Practice Address - Country:US
Practice Address - Phone:815-363-1163
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-09
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-005473111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILT38671Medicare UPIN