Provider Demographics
NPI:1548372576
Name:REIF, DAVID C (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:C
Last Name:REIF
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 1:1329 W GRAND AVE
Mailing Address - Street 2:STE 4
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53074-2010
Mailing Address - Country:US
Mailing Address - Phone:262-284-7246
Mailing Address - Fax:
Practice Address - Street 1:1000 N WISCONSIN ST
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:WI
Practice Address - Zip Code:53074-1285
Practice Address - Country:US
Practice Address - Phone:262-284-7246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3605-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38923600Medicaid
WI70140Medicare ID - Type Unspecified