1023188802 NPI number — MS. MICHELLE KRISTINE REISINGER DC

Table of content: MS. MICHELLE KRISTINE REISINGER DC (NPI 1023188802)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023188802 NPI number — MS. MICHELLE KRISTINE REISINGER DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REISINGER
Provider First Name:
MICHELLE
Provider Middle Name:
KRISTINE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023188802
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/12/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 20TH ST NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STEWARTVILLE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55976-1003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-533-4777
Provider Business Mailing Address Fax Number:
507-533-4778

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1067 4TH ST NE
Provider Second Line Business Practice Location Address:
SUITE 550
Provider Business Practice Location Address City Name:
BYRON
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55920-5002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-775-2400
Provider Business Practice Location Address Fax Number:
507-775-2401
Provider Enumeration Date:
11/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  4613 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1023188802 . This is a "MEDICARE-TYPE UNSPECIFIED" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1023188802 . This is a "BCBS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1023188802 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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