Provider Demographics
NPI:1821035692
Name:REESE, SEAN ALAN (DC)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:ALAN
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 1:1118 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-2517
Mailing Address - Country:US
Mailing Address - Phone:910-343-2900
Mailing Address - Fax:
Practice Address - Street 1:2210 WRIGHTSVILLE AVE
Practice Address - Street 2:SUITE 3C
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-2406
Practice Address - Country:US
Practice Address - Phone:910-392-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2068111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890876NMedicaid
NC49345Medicare UPIN
NC2454152Medicare ID - Type Unspecified