Provider Demographics
NPI:1457491953
Name:REIDT, RICK JAMES (DC)
Entity Type:Individual
Prefix:
First Name:RICK
Middle Name:JAMES
Last Name:REIDT
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 1:600 INWOOD AVE N
Mailing Address - Street 2:SUITE240
Mailing Address - City:OAKDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55128-7096
Mailing Address - Country:US
Mailing Address - Phone:651-735-1580
Mailing Address - Fax:651-735-0545
Practice Address - Street 1:600 INWOOD AVE N
Practice Address - Street 2:SUITE240
Practice Address - City:OAKDALE
Practice Address - State:MN
Practice Address - Zip Code:55128-7096
Practice Address - Country:US
Practice Address - Phone:651-735-1580
Practice Address - Fax:651-735-0545
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2332111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN57G65REOtherBCBS
MNT39455Medicare UPIN