Provider Demographics
NPI:1366649592
Name:REESE, DOUGLAS K (DC)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:K
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 1:265 N WESTGATE AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62650-1700
Mailing Address - Country:US
Mailing Address - Phone:217-245-4810
Mailing Address - Fax:217-245-0931
Practice Address - Street 1:265 N WESTGATE AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:IL
Practice Address - Zip Code:62650-1700
Practice Address - Country:US
Practice Address - Phone:217-245-4810
Practice Address - Fax:217-245-0931
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046346OtherHEALTH ALLIANCE
ILK46834Medicare PIN