Provider Demographics
NPI:1912398991
Name:REICHELT, GARRETT ILG (DC)
Entity Type:Individual
Prefix:DR
First Name:GARRETT
Middle Name:ILG
Last Name:REICHELT
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 1:59 LINDEN ST
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-2231
Mailing Address - Country:US
Mailing Address - Phone:631-682-1544
Mailing Address - Fax:
Practice Address - Street 1:560 NORTHERN BLVD
Practice Address - Street 2:STE 106B
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5100
Practice Address - Country:US
Practice Address - Phone:631-682-1544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-11
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012632111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor