Provider Demographics
NPI:1962844860
Name:REESE, SHAQUALA (DC)
Entity type:Individual
Prefix:
First Name:SHAQUALA
Middle Name:
Last Name:REESE
Suffix:
Gender:
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:486 W BOUGHTON RD # A1-A3
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-2399
Mailing Address - Country:US
Mailing Address - Phone:630-864-6486
Mailing Address - Fax:331-757-5902
Practice Address - Street 1:486 W BOUGHTON RD # A1-A3
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-2399
Practice Address - Country:US
Practice Address - Phone:630-864-6486
Practice Address - Fax:331-757-5902
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-22
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012396111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor