Provider Demographics
NPI:1891099594
Name:REINICHE, JOHN CARL
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:CARL
Last Name:REINICHE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANTENO
Mailing Address - State:IL
Mailing Address - Zip Code:60950-1534
Mailing Address - Country:US
Mailing Address - Phone:815-468-9622
Mailing Address - Fax:815-468-9644
Practice Address - Street 1:51 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MANTENO
Practice Address - State:IL
Practice Address - Zip Code:60950-1534
Practice Address - Country:US
Practice Address - Phone:815-468-9622
Practice Address - Fax:815-468-9644
Is Sole Proprietor?:No
Enumeration Date:2011-01-10
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2996237700000X
IN17001308A237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist