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General NPI Number Information
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NPI Number | 1962543629
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Entity Type | Individual
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Provider Name | FORREST DAVID REISE D.C.,C.C.S.P.
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Gender | Male
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Dates
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Enumeration Date | 02/08/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4671 MERCER UNIVERSITY DR
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City | MACON
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State | GA
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Zip | 31210-5611
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Country | US
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Telephone | 478-475-9990
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Fax | 478-475-0661
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Provider Business Mailing Address
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Address Line | PO BOX 26339
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City | MACON
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State | GA
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Zip | 31221-6339
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Country | US
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Telephone | 478-475-9990
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Fax | 478-475-0661
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | CHIR002271
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License Number State | GA
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