Provider Demographics
NPI:1053475640
Name:REICHERT, JONATHAN A (DC)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:A
Last Name:REICHERT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6502 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-2380
Mailing Address - Country:US
Mailing Address - Phone:614-866-7776
Mailing Address - Fax:
Practice Address - Street 1:6502 E MAIN ST
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-2380
Practice Address - Country:US
Practice Address - Phone:614-866-7776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4374111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0398163Medicaid
OH000000384994OtherANTHEM OH ID
OH000000384994OtherANTHEM OH ID
OHU65220Medicare UPIN