Provider Demographics
NPI:1780757815
Name:REESON, DUSTIN ALAN (DC)
Entity type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:ALAN
Last Name:REESON
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 1:3029 ALLIES LN
Mailing Address - Street 2:
Mailing Address - City:CROSS PLAINS
Mailing Address - State:WI
Mailing Address - Zip Code:53528-9264
Mailing Address - Country:US
Mailing Address - Phone:563-940-1600
Mailing Address - Fax:
Practice Address - Street 1:2034 MAIN ST
Practice Address - Street 2:SUITE 4
Practice Address - City:CROSS PLAINS
Practice Address - State:WI
Practice Address - Zip Code:53528-8855
Practice Address - Country:US
Practice Address - Phone:608-798-3437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4130-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38960900Medicaid
WIV04639Medicare UPIN
WI000115052Medicare ID - Type Unspecified