Provider Demographics
NPI:1093984015
Name:REESE, MARK (LAC)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:REESE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5054 N SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-3118
Mailing Address - Country:US
Mailing Address - Phone:773-506-8971
Mailing Address - Fax:
Practice Address - Street 1:5054 N SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-3118
Practice Address - Country:US
Practice Address - Phone:773-506-8971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-23
Last Update Date:2008-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist