Provider Demographics
NPI:1386686863
Name:REESE FAMILY CHIROPRACTIC SERVICE CORPORATION
Entity Type:Organization
Organization Name:REESE FAMILY CHIROPRACTIC SERVICE CORPORATION
Other - Org Name:DOUGLAS K REESE DC
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:K
Authorized Official - Last Name:REESE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:217-245-4810
Mailing Address - Street 1:265 N WESTGATE AVE
Mailing Address - Street 2:REESE FAMILY CHIROPRACTIC SC
Mailing Address - City:JACKSONVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62650
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:REESE FAMILY CHIROPRACTIC SC
Practice Address - City:JACKSONVILLE
Practice Address - State:IL
Practice Address - Zip Code:62650
Practice Address - Country:US
Practice Address - Phone:217-245-4810
Practice Address - Fax:217-245-0931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL6982010OtherBCBS
IL6982010OtherBCBS