=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447423777
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LUCAS JOHN REINECK D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/08/2008
-----------------------------------------------------
Last Update Date | 10/29/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1007 STATE ROUTE 28 STE C
-----------------------------------------------------
City | MILFORD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45150-2094
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-831-4433
-----------------------------------------------------
Fax | 513-831-4440
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6045 DELICIOUS ASHA CT
-----------------------------------------------------
City | LOVELAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45140-8189
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-509-9803
-----------------------------------------------------
Fax | 513-831-4440
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 3892
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------