Provider Demographics
NPI:1306027487
Name:REARDON, CASEY EVANS (DC)
Entity Type:Individual
Prefix:DR
First Name:CASEY
Middle Name:EVANS
Last Name:REARDON
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 1:317 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:MERCER
Mailing Address - State:PA
Mailing Address - Zip Code:16137-1314
Mailing Address - Country:US
Mailing Address - Phone:724-931-0035
Mailing Address - Fax:
Practice Address - Street 1:348 MAIN ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:PA
Practice Address - Zip Code:16125-2608
Practice Address - Country:US
Practice Address - Phone:724-588-5250
Practice Address - Fax:724-588-5253
Is Sole Proprietor?:No
Enumeration Date:2007-11-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009840111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0099633Medicaid
PA1026729350002Medicaid