Provider Demographics
NPI:1386680833
Name:REETZ, MARK A (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:REETZ
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 1:115 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:IA
Mailing Address - Zip Code:52057-1535
Mailing Address - Country:US
Mailing Address - Phone:563-927-2961
Mailing Address - Fax:563-927-3846
Practice Address - Street 1:115 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:IA
Practice Address - Zip Code:52057-1535
Practice Address - Country:US
Practice Address - Phone:563-927-2961
Practice Address - Fax:563-927-3846
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05878111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0160945Medicaid
IA40039OtherBLUE SHIELD OF IOWA CHIRO
IA40039Medicare ID - Type UnspecifiedCHIROPRACTOR
IAU66497Medicare UPIN