Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 9123542-1202 | UT |
Y | 111NS0005X | Chiropractic Sports Physician | 9123542-1202 | UT |
NPI | 1003217449 |
---|---|
Provider Name | Dr. Andrew J Reheisse |
First Address | Midvale, UT 84047-1869 |
Second Address | Midvale, UT 84047-1869 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/09/2014 |
Last Update Date | 01/10/2020 |