Provider Demographics
NPI:1811970924
Name:REIZER, STEVEN LEE (DC)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:LEE
Last Name:REIZER
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 1:415 RHAPSODY LN
Mailing Address - Street 2:
Mailing Address - City:BOILING SPRINGS
Mailing Address - State:SC
Mailing Address - Zip Code:29316-5696
Mailing Address - Country:US
Mailing Address - Phone:864-578-0781
Mailing Address - Fax:
Practice Address - Street 1:4222 HIGHWAY 9
Practice Address - Street 2:
Practice Address - City:BOILING SPRINGS
Practice Address - State:SC
Practice Address - Zip Code:29316-6004
Practice Address - Country:US
Practice Address - Phone:864-814-2222
Practice Address - Fax:864-814-2209
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-22
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2058111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH2058Medicaid
SCCH2058Medicaid