Provider Demographics
NPI:1962844860
Name:REESE, SHAQUALA (DC)
Entity Type:Individual
Prefix:
First Name:SHAQUALA
Middle Name:
Last Name:REESE
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 1:246 E JANATA BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-5378
Mailing Address - Country:US
Mailing Address - Phone:630-344-3267
Mailing Address - Fax:630-523-5450
Practice Address - Street 1:246 E JANATA BLVD STE 210
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-5378
Practice Address - Country:US
Practice Address - Phone:630-344-3267
Practice Address - Fax:630-523-5450
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-22
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012396111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor