Provider Demographics
NPI:1821288762
Name:DANIEL OLIVER REITER
Entity Type:Organization
Organization Name:DANIEL OLIVER REITER
Other - Org Name:REITER CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:OLIVER
Authorized Official - Last Name:REITER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:573-358-7655
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:573-358-7655
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:573-358-7655
Practice Address - Fax:573-358-7652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004488111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO504578907Medicaid
MO504578907Medicaid
MOT43419Medicare UPIN