Provider Demographics
NPI:1366478968
Name:REISER, SARA CATHERINE (DC)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:CATHERINE
Last Name:REISER
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 1:2025 NICOLLET AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-2552
Mailing Address - Country:US
Mailing Address - Phone:612-871-1100
Mailing Address - Fax:612-874-6141
Practice Address - Street 1:2025 NICOLLET AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-2552
Practice Address - Country:US
Practice Address - Phone:612-871-1100
Practice Address - Fax:612-874-6141
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-24
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN003584111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN044727700Medicaid
MN044727700Medicaid