Provider Demographics
NPI:1194036871
Name:REASOR CHIROPRACTIC PC
Entity Type:Organization
Organization Name:REASOR CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:M
Authorized Official - Last Name:REASOR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:812-883-6527
Mailing Address - Street 1:804 S JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:IN
Mailing Address - Zip Code:47167-1200
Mailing Address - Country:US
Mailing Address - Phone:812-883-6527
Mailing Address - Fax:812-883-6528
Practice Address - Street 1:804 S JACKSON ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:IN
Practice Address - Zip Code:47167-1200
Practice Address - Country:US
Practice Address - Phone:812-883-6527
Practice Address - Fax:812-883-6528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-28
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002101A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1821163841OtherINDIVIDUAL NPI