Provider Demographics
NPI:1962641845
Name:REINEKING CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:REINEKING CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER,
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:REINEKING
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-733-9999
Mailing Address - Street 1:2210 S 42ND ST APT 10
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-8624
Mailing Address - Country:US
Mailing Address - Phone:920-733-9999
Mailing Address - Fax:920-733-9998
Practice Address - Street 1:2210 S 42ND ST APT 10
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-8624
Practice Address - Country:US
Practice Address - Phone:920-733-9999
Practice Address - Fax:920-733-9998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-17
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4456-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty