Provider Demographics
NPI:1255487971
Name:REEVE CHIROPRACTIC CLINIC, P.A.
Entity Type:Organization
Organization Name:REEVE CHIROPRACTIC CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:OWEN
Authorized Official - Last Name:REEVE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:507-437-3655
Mailing Address - Street 1:308 4TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:MN
Mailing Address - Zip Code:55912-3140
Mailing Address - Country:US
Mailing Address - Phone:507-437-3655
Mailing Address - Fax:507-433-1613
Practice Address - Street 1:308 4TH AVE NW
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:MN
Practice Address - Zip Code:55912-3140
Practice Address - Country:US
Practice Address - Phone:507-437-3655
Practice Address - Fax:507-433-1613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1590111N00000X
MN4613111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1590OtherMN LICENSE NUMBER
MN32331REOtherBCBS GROUP NUMBER
MN4613OtherMN LICENSE NUMBER
MN078882100Medicaid
MN4613OtherMN LICENSE NUMBER
MNT66043Medicare UPIN
MNC02299Medicare ID - Type UnspecifiedGROUP#