Healthcare Provider Details

I. General information

NPI: 1275553380
Provider Name (Legal Business Name): JOHN L REIZER DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 10/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1518 E RUTHERFORD ST
LANDRUM SC
29356-1416
US

IV. Provider business mailing address

68 GLOBAL DR SUITE 100
GREENVILLE SC
29607-4628
US

V. Phone/Fax

Practice location:
  • Phone: 864-494-0121
  • Fax:
Mailing address:
  • Phone: 864-644-2700
  • Fax: 864-644-2709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2379
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: