Provider Demographics
NPI:1932252657
Name:RENO CHIROPRACTIC CENTER PC
Entity Type:Organization
Organization Name:RENO CHIROPRACTIC CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:RENO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:586-264-4700
Mailing Address - Street 1:11429 15 MILE RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-3809
Mailing Address - Country:US
Mailing Address - Phone:586-264-4700
Mailing Address - Fax:586-264-1955
Practice Address - Street 1:11429 15 MILE RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312-3809
Practice Address - Country:US
Practice Address - Phone:586-264-4700
Practice Address - Fax:586-264-1955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDR005321111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4525702Medicaid
MI0P21860Medicare ID - Type Unspecified
MI4525702Medicaid