Provider Demographics
NPI:1962595736
Name:REEFER, ALAN RICHARDSON (DC)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:RICHARDSON
Last Name:REEFER
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:PO BOX 293
Mailing Address - Street 2:9355 RT 422 HWY W
Mailing Address - City:SHELOCTA
Mailing Address - State:PA
Mailing Address - Zip Code:15774
Mailing Address - Country:US
Mailing Address - Phone:724-354-4444
Mailing Address - Fax:724-354-4360
Practice Address - Street 1:9355 RT 422 HWY W
Practice Address - Street 2:
Practice Address - City:SHELOCTA
Practice Address - State:PA
Practice Address - Zip Code:15774
Practice Address - Country:US
Practice Address - Phone:724-354-4444
Practice Address - Fax:724-354-4360
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003295L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010480270001Medicaid
000910929OtherHIGHMARK BLUE SHIELD
306379OtherUPMC
350038558OtherRAILROAD MEDICARE
RE419704OtherHIGHMARK BLUE SHIELD
1352627OtherUMWA MEDICARE
PA0010480270001Medicaid
RE419704Medicare PIN
1352627OtherUMWA MEDICARE