Provider Demographics
NPI:1992815310
Name:REESE, RUSSELL DALE (DC)
Entity type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:DALE
Last Name:REESE
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 1:7677 CENTER AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-9102
Mailing Address - Country:US
Mailing Address - Phone:714-895-9355
Mailing Address - Fax:714-895-5485
Practice Address - Street 1:7677 CENTER AVE STE 202
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-9102
Practice Address - Country:US
Practice Address - Phone:714-895-9355
Practice Address - Fax:714-895-5485
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC19953111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor