Provider Demographics
NPI:1518962869
Name:REITER, DANIEL O (DC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:O
Last Name:REITER
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:PO BOX 436
Mailing Address - Street 2:
Mailing Address - City:BONNE TERRE
Mailing Address - State:MO
Mailing Address - Zip Code:63628-0436
Mailing Address - Country:US
Mailing Address - Phone:573-358-3356
Mailing Address - Fax:573-358-7652
Practice Address - Street 1:21 W SCHOOL ST
Practice Address - Street 2:
Practice Address - City:BONNE TERRE
Practice Address - State:MO
Practice Address - Zip Code:63628-1509
Practice Address - Country:US
Practice Address - Phone:573-358-3356
Practice Address - Fax:573-358-7652
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004488111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO753261106Medicaid
MO9900001632Medicare PIN
MOT43419Medicare UPIN