MEDICARE: REEVE CHIROPRACTIC CLINIC, P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	4613	MN
2	111N00000X	Chiropractor	1590	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1590	OTHER	MN	MN LICENSE NUMBER
2	32331RE	OTHER	MN	BCBS GROUP NUMBER
3	4613	OTHER	MN	MN LICENSE NUMBER
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255487971
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REEVE CHIROPRACTIC CLINIC, P.A.

Provider Business Mailing Address
First Line	:	308 4TH AVE NW
Second Line	:
City	:	AUSTIN
State	:	MN
Zip	:	55912-3140
Country	:	US
Telephone Number	:	507-437-3655
Fax Number	:	507-433-1613

Provider Business Practice Location Address
First Line	:	308 4TH AVE NW
Second Line	:
City	:	AUSTIN
State	:	MN
Zip	:	55912-3140
Country	:	US
Telephone Number	:	507-437-3655
Fax Number	:	507-433-1613

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MARK OWEN REEVE
Credential	:	D.C.
Telephone Number	:	507-437-3655

Provider Enumeration Date	:	01/26/2007
Last Update Date	:	09/09/2011

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Directions to “REEVE CHIROPRACTIC CLINIC, P.A. ” Practice Location

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