MEDICARE: JESS RIETZKE D.C, B.S.

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	APPLIED FOR	KS

General Provider Information

NPI Number	:	1356762678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESS RIETZKE D.C, B.S.

Provider Business Mailing Address
First Line	:	121 W MAIN ST
Second Line	:
City	:	OSBORNE
State	:	KS
Zip	:	67473-2402
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	121 W MAIN ST
Second Line	:
City	:	OSBORNE
State	:	KS
Zip	:	67473-2402
Country	:	US
Telephone Number	:	785-346-2023
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/05/2014
Last Update Date	:	01/05/2014

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