Healthcare Provider Details

I. General information

NPI: 1215923602
Provider Name (Legal Business Name): REGGIE LAUER CLIFTON DC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 CAPEHART RD
OFFUTT A F B NE
68113-1043
US

IV. Provider business mailing address

1219 E EUCLID AVE
INDIANOLA IA
50125-1635
US

V. Phone/Fax

Practice location:
  • Phone: 402-294-9495
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberA05317
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: