Provider Demographics
NPI:1134217151
Name:REISER, SCOTT G (DC)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:G
Last Name:REISER
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 1:36735 N IL ROUTE 83
Mailing Address - Street 2:
Mailing Address - City:LAKE VILLA
Mailing Address - State:IL
Mailing Address - Zip Code:60046-9619
Mailing Address - Country:US
Mailing Address - Phone:847-265-5600
Mailing Address - Fax:847-245-4491
Practice Address - Street 1:36735 N IL ROUTE 83
Practice Address - Street 2:
Practice Address - City:LAKE VILLA
Practice Address - State:IL
Practice Address - Zip Code:60046-9619
Practice Address - Country:US
Practice Address - Phone:847-265-5600
Practice Address - Fax:847-245-4491
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-006409111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU05485Medicare UPIN
IL932820Medicare ID - Type Unspecified