MEDICARE: DR. KIRSTEN F REAY D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	038008180	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	05622784	OTHER	IL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1205921558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIRSTEN F REAY D.C.

Provider Business Mailing Address
First Line	:	5463 BULL VALLEY RD
Second Line	:
City	:	MCHENRY
State	:	IL
Zip	:	60050-7410
Country	:	US
Telephone Number	:	815-653-0077
Fax Number	:

Provider Business Practice Location Address
First Line	:	5323 E WONDER LAKE RD
Second Line	:
City	:	WONDER LAKE
State	:	IL
Zip	:	60097-9051
Country	:	US
Telephone Number	:	815-653-0077
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	08/18/2019

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