Provider Demographics
NPI:1790818912
Name:REESE, CRAIG (DC)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:
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 1:6666 GUNPARK DR
Mailing Address - Street 2:#101
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-3395
Mailing Address - Country:US
Mailing Address - Phone:303-447-1300
Mailing Address - Fax:303-447-1333
Practice Address - Street 1:6666 GUNPARK DR
Practice Address - Street 2:#101
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-3395
Practice Address - Country:US
Practice Address - Phone:303-447-1300
Practice Address - Fax:303-447-1333
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2492111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO441798Medicare ID - Type Unspecified