Provider Demographics
NPI:1760412670
Name:REESER, KELSEY (DC)
Entity Type:Individual
Prefix:DR
First Name:KELSEY
Middle Name:
Last Name:REESER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745 NE 7TH ST
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-1632
Mailing Address - Country:US
Mailing Address - Phone:541-472-0500
Mailing Address - Fax:541-471-6285
Practice Address - Street 1:745 NE 7TH ST
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-1632
Practice Address - Country:US
Practice Address - Phone:541-472-0500
Practice Address - Fax:541-471-6285
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3563111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR880 531 000OtherREGENCE PROVIDER NUMBER
OR3094394OtherPACIFIC SOURCE PROVIDER NUMBER
ORR134195OtherPTAN
ORV08614Medicare UPIN