Provider Demographics
NPI:1083761043
Name:RHEINECKER, RENEE LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:RENEE
Middle Name:LYNN
Last Name:RHEINECKER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12419 BLACKSTUMP RD
Mailing Address - Street 2:
Mailing Address - City:PERCY
Mailing Address - State:IL
Mailing Address - Zip Code:62272-1007
Mailing Address - Country:US
Mailing Address - Phone:618-615-9409
Mailing Address - Fax:
Practice Address - Street 1:108 N SPARTA ST
Practice Address - Street 2:
Practice Address - City:STEELEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62288-1541
Practice Address - Country:US
Practice Address - Phone:618-965-9555
Practice Address - Fax:618-965-9556
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL38010877111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor