Provider Demographics
NPI:1033554043
Name:REESE, JENNA R (DC)
Entity Type:Individual
Prefix:DR
First Name:JENNA
Middle Name:R
Last Name:REESE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MS
Other - First Name:JENNA
Other - Middle Name:R
Other - Last Name:NUNN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4603 FM 1463 RD 400
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-6545
Mailing Address - Country:US
Mailing Address - Phone:832-913-8970
Mailing Address - Fax:832-201-9629
Practice Address - Street 1:4603 FM 1463 RD 400
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-6545
Practice Address - Country:US
Practice Address - Phone:832-913-8970
Practice Address - Fax:832-201-9629
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-03
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12240111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX12240OtherMEDICAL LICENSE
TX760609536OtherTAMG TIN
TX12240OtherMEDICAL LICENSE