MEDICARE: REICH CHIROPRACTIC CLINIC PC

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	3400012	WI
2	111N00000X	Chiropractor	038006052	IL

General Provider Information

NPI Number	:	1891777082
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REICH CHIROPRACTIC CLINIC PC

Provider Business Mailing Address
First Line	:	1831 BLACKHAWK BLVD
Second Line	:
City	:	SOUTH BELOIT
State	:	IL
Zip	:	61080-2499
Country	:	US
Telephone Number	:	815-389-1492
Fax Number	:	815-389-1495

Provider Business Practice Location Address
First Line	:	1831 BLACKHAWK BLVD
Second Line	:
City	:	SOUTH BELOIT
State	:	IL
Zip	:	61080-2499
Country	:	US
Telephone Number	:	815-389-1492
Fax Number	:	815-389-1495

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BRADLEY J REICH
Credential	:	DC
Telephone Number	:	815-389-1492

Provider Enumeration Date	:	11/15/2005
Last Update Date	:	03/18/2015

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