Provider Demographics
NPI:1689856213
Name:REINBOLDT, DANIEL K (DC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:K
Last Name:REINBOLDT
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 1:2806 MITCHELL ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75402-8939
Mailing Address - Country:US
Mailing Address - Phone:903-454-2225
Mailing Address - Fax:
Practice Address - Street 1:2806 MITCHELL ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75402-8939
Practice Address - Country:US
Practice Address - Phone:903-454-2225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-05
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC5056111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXCO603374Medicaid
TX4324263OtherAETNA
TX8H3830OtherBCBS
TXCO603374Medicaid