Healthcare Provider Details

I. General information

NPI: 1962844860
Provider Name (Legal Business Name): SHAQUALA REESE D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2013
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

486 W BOUGHTON RD # A1-A3
BOLINGBROOK IL
60440-2399
US

IV. Provider business mailing address

486 W BOUGHTON RD # A1-A3
BOLINGBROOK IL
60440-2399
US

V. Phone/Fax

Practice location:
  • Phone: 630-864-6486
  • Fax: 331-757-5902
Mailing address:
  • Phone: 630-864-6486
  • Fax: 331-757-5902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038012396
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: