Provider Demographics
NPI:1235287582
Name:REESON CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:REESON CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:REESON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-798-3437
Mailing Address - Street 1:3029 ALLIES LN
Mailing Address - Street 2:
Mailing Address - City:CROSS PLAINS
Mailing Address - State:WI
Mailing Address - Zip Code:53528-9264
Mailing Address - Country:US
Mailing Address - Phone:563-940-1600
Mailing Address - Fax:
Practice Address - Street 1:2034 MAIN ST
Practice Address - Street 2:SUITE 4
Practice Address - City:CROSS PLAINS
Practice Address - State:WI
Practice Address - Zip Code:53528-8855
Practice Address - Country:US
Practice Address - Phone:608-798-3437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4130-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38960900Medicaid
WIV04639Medicare UPIN
WI000115052Medicare ID - Type Unspecified