Provider Demographics
NPI:1811088503
Name:REETZ, WAYNE W (DC)
Entity type:Individual
Prefix:
First Name:WAYNE
Middle Name:W
Last Name:REETZ
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 1:2 MOUNT PLEASANT DRIVE
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960
Mailing Address - Country:US
Mailing Address - Phone:978-531-1000
Mailing Address - Fax:978-977-9715
Practice Address - Street 1:2 MOUNT PLEASANT DRIVE
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960
Practice Address - Country:US
Practice Address - Phone:978-531-1000
Practice Address - Fax:978-977-9715
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA337111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAREY35063OtherBCBS OF MA
MA719797OtherTUFTS
MAREY35063OtherBCBS OF MA