Provider Demographics
NPI:1497782411
Name:REESE, ERIC W (DC)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:W
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 1:3854 SHERIDAN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3630
Mailing Address - Country:US
Mailing Address - Phone:954-989-2323
Mailing Address - Fax:954-989-2325
Practice Address - Street 1:3854 SHERIDAN ST
Practice Address - Street 2:SUITE B
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3630
Practice Address - Country:US
Practice Address - Phone:954-989-2323
Practice Address - Fax:954-989-2325
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0007421111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55673OtherBLUE CROSS BLUE SHIELD
FLE0306AMedicare ID - Type Unspecified
FL55673OtherBLUE CROSS BLUE SHIELD