Provider Demographics
NPI:1780762211
Name:REICHE, BRENT THOMAS (DC)
Entity type:Individual
Prefix:DR
First Name:BRENT
Middle Name:THOMAS
Last Name:REICHE
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 1:439 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-1528
Mailing Address - Country:US
Mailing Address - Phone:207-571-8028
Mailing Address - Fax:866-213-8201
Practice Address - Street 1:439 MAIN ST
Practice Address - Street 2:
Practice Address - City:SACO
Practice Address - State:ME
Practice Address - Zip Code:04072-1528
Practice Address - Country:US
Practice Address - Phone:207-571-8028
Practice Address - Fax:866-213-8207
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR1313111N00000X
WI3726111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM937401OtherPTAN
MEU56702OtherHARVARD PILGRAM
ME022530OtherBLUE CROSS BLUE SHEILD
ME05Z044016ME02OtherFEDERAL EMPLOYEE PLANS
ME05Z044016ME02OtherFEDERAL EMPLOYEE PLANS