Provider Demographics
NPI:1063573863
Name:REAMS, DALE RUBERT (DC)
Entity type:Individual
Prefix:DR
First Name:DALE
Middle Name:RUBERT
Last Name:REAMS
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 1:129 EAST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:NANTICOKE
Mailing Address - State:PA
Mailing Address - Zip Code:18634-1619
Mailing Address - Country:US
Mailing Address - Phone:570-735-7400
Mailing Address - Fax:
Practice Address - Street 1:129 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:NANTICOKE
Practice Address - State:PA
Practice Address - Zip Code:18634-1619
Practice Address - Country:US
Practice Address - Phone:570-735-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002778L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009658910002Medicaid
PA0009658910002Medicaid