Provider Demographics
NPI:1316912777
Name:REESE, GREGORY T (DC)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:T
Last Name:REESE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:18 COURTYARD OFFICES
Mailing Address - Street 2:
Mailing Address - City:SELINSGROVE
Mailing Address - State:PA
Mailing Address - Zip Code:17870-9375
Mailing Address - Country:US
Mailing Address - Phone:570-743-2342
Mailing Address - Fax:570-743-7214
Practice Address - Street 1:18 COURTYARD OFFICES
Practice Address - Street 2:
Practice Address - City:SELINSGROVE
Practice Address - State:PA
Practice Address - Zip Code:17870-9375
Practice Address - Country:US
Practice Address - Phone:570-743-2342
Practice Address - Fax:570-743-7214
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004393L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA350028533OtherUNITED HEALTHCARE RR
PA604347OtherBLUE SHIELD
PA516950OtherUS HEALTHCARE
PA39757OtherHEALTH AMERICA
PA3000177OtherKEYSTONE HEALTHPLAN
PA02804100OtherCAPITAL BLUE CROSS
PA0012136950001Medicaid
PA604347OtherBLUE SHEILD