Healthcare Provider Details

I. General information

NPI: 1821035692
Provider Name (Legal Business Name): SEAN ALAN REESE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2210 WRIGHTSVILLE AVE SUITE 3C
WILMINGTON NC
28403-2406
US

IV. Provider business mailing address

1118 COUNTRY CLUB RD
WILMINGTON NC
28403-2517
US

V. Phone/Fax

Practice location:
  • Phone: 910-392-3100
  • Fax:
Mailing address:
  • Phone: 910-343-2900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number2068
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: