Provider Demographics
NPI:1750315503
Name:REINER, LYDIA DANIELLE (DC)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:DANIELLE
Last Name:REINER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2851 PARK MARINA DR STE 100
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-2800
Mailing Address - Country:US
Mailing Address - Phone:530-245-0402
Mailing Address - Fax:530-241-5072
Practice Address - Street 1:2851 PARK MARINA DR STE 100
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-2800
Practice Address - Country:US
Practice Address - Phone:530-245-0402
Practice Address - Fax:530-241-5072
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29939111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0299390OtherBLUE SHIELD PROVIDER NUMB
CADC0299390OtherBLUE SHIELD PROVIDER NUMB