Provider Demographics
NPI:1205921558
Name:REAY, KIRSTEN F (DC)
Entity type:Individual
Prefix:DR
First Name:KIRSTEN
Middle Name:F
Last Name:REAY
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 1:5463 BULL VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-7410
Mailing Address - Country:US
Mailing Address - Phone:815-653-0077
Mailing Address - Fax:
Practice Address - Street 1:5323 E WONDER LAKE RD
Practice Address - Street 2:
Practice Address - City:WONDER LAKE
Practice Address - State:IL
Practice Address - Zip Code:60097-9051
Practice Address - Country:US
Practice Address - Phone:815-653-0077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2019-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038008180111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL05622784OtherBLUE CROSS BLUE SHIELD
IL05622784OtherBLUE CROSS BLUE SHIELD
IL509070Medicare ID - Type Unspecified