Provider Demographics
NPI:1710103122
Name:REUTZEL, BRETT ERIC (DC)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:ERIC
Last Name:REUTZEL
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 1:506 PITTSBURGH ST.
Mailing Address - Street 2:P.O. BOX 398
Mailing Address - City:MARS
Mailing Address - State:PA
Mailing Address - Zip Code:16046-0398
Mailing Address - Country:US
Mailing Address - Phone:724-625-3200
Mailing Address - Fax:724-625-3300
Practice Address - Street 1:506 PITTSBURGH ST.
Practice Address - Street 2:
Practice Address - City:MARS
Practice Address - State:PA
Practice Address - Zip Code:16046-0398
Practice Address - Country:US
Practice Address - Phone:724-625-3200
Practice Address - Fax:724-625-3300
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC 004864L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00046455OtherWORK COMP.
PA003317OtherUPMC
PA01798896Medicaid
PA01798896Medicaid
PAU 38755Medicare UPIN