Healthcare Provider Details

I. General information

NPI: 1144845660
Provider Name (Legal Business Name): MICHELA REESE DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2020
Last Update Date: 07/25/2022
Certification Date: 07/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3027 MT 83 SUITE L
SEELEY LAKE MT
59868-5986
US

IV. Provider business mailing address

PO BOX 139
SEELEY LAKE MT
59868-0139
US

V. Phone/Fax

Practice location:
  • Phone: 406-677-3617
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number8103
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHI-CHI-LIC-6731
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: