Provider Demographics
NPI:1962874701
Name:REIGH, SAMARA (LAC)
Entity type:Individual
Prefix:
First Name:SAMARA
Middle Name:
Last Name:REIGH
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2432 N LINDEN PL APT 108
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-2835
Mailing Address - Country:US
Mailing Address - Phone:773-276-2801
Mailing Address - Fax:
Practice Address - Street 1:2432 N LINDEN PL APT 108
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-2835
Practice Address - Country:US
Practice Address - Phone:773-276-2801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-20
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198001282171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist