MEDICARE: DR. ERIC W REESE 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	CH0007421	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	55673	OTHER	FL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1497782411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC W REESE D.C.

Provider Business Mailing Address
First Line	:	3854 SHERIDAN ST
Second Line	:	SUITE B
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-3630
Country	:	US
Telephone Number	:	954-989-2323
Fax Number	:	954-989-2325

Provider Business Practice Location Address
First Line	:	3854 SHERIDAN ST
Second Line	:	SUITE B
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-3630
Country	:	US
Telephone Number	:	954-989-2323
Fax Number	:	954-989-2325

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

Provider Enumeration Date	:	06/26/2006
Last Update Date	:	07/08/2007

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