Provider Demographics
NPI:1770959165
Name:REESE CHIROPRACTIC SPINE BY DESIGN
Entity type:Organization
Organization Name:REESE CHIROPRACTIC SPINE BY DESIGN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:WENTZEL
Authorized Official - Last Name:HULS
Authorized Official - Suffix:
Authorized Official - Credentials:DC, RN, RD
Authorized Official - Phone:740-296-9347
Mailing Address - Street 1:4603 FM 1463 RD STE 400
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-6545
Mailing Address - Country:US
Mailing Address - Phone:832-913-8970
Mailing Address - Fax:
Practice Address - Street 1:4603 FM 1463 RD STE 400
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-6545
Practice Address - Country:US
Practice Address - Phone:832-913-8970
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-19
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12408305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization