Provider Demographics
NPI:1164463246
Name:REESE, J. WESTON HEATH (DC)
Entity Type:Individual
Prefix:
First Name:J. WESTON
Middle Name:HEATH
Last Name:REESE
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 1:1505 S SANGRE
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074
Mailing Address - Country:US
Mailing Address - Phone:405-372-9200
Mailing Address - Fax:
Practice Address - Street 1:1505 S SANGRE
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074
Practice Address - Country:US
Practice Address - Phone:405-372-9200
Practice Address - Fax:405-372-9203
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3614111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK245602405Medicare ID - Type Unspecified
OKU90352Medicare UPIN