Provider Demographics
NPI:1710101407
Name:REICHARDT, CHRISTIAN HERMAN (DC)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:HERMAN
Last Name:REICHARDT
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 1:1347 23RD ST # S102
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2025
Mailing Address - Country:US
Mailing Address - Phone:310-829-0453
Mailing Address - Fax:310-829-0455
Practice Address - Street 1:1347 23RD ST # S102
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2025
Practice Address - Country:US
Practice Address - Phone:310-829-0453
Practice Address - Fax:310-829-0455
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC16824111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician