Healthcare Provider Details

I. General information

NPI: 1154508745
Provider Name (Legal Business Name): REITER CHIROPRACTIC & REHAB CTR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2008
Last Update Date: 01/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6350 S PULASKI RD
CHICAGO IL
60629-4706
US

IV. Provider business mailing address

6350 S PULASKI RD
CHICAGO IL
60629-4706
US

V. Phone/Fax

Practice location:
  • Phone: 773-767-2225
  • Fax: 773-767-9604
Mailing address:
  • Phone: 773-767-2225
  • Fax: 773-767-9604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number StateIL

VIII. Authorized Official

Name: MRS. GABRIELA MENDOZA
Title or Position: BILLER
Credential:
Phone: 773-767-2225