MEDICARE: SAMARA REIGH LAC

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	171100000X	Acupuncturist	198001282	IL

General Provider Information

NPI Number	:	1962874701
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMARA REIGH LAC

Provider Business Mailing Address
First Line	:	2432 N LINDEN PL APT 108
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-2835
Country	:	US
Telephone Number	:	773-276-2801
Fax Number	:

Provider Business Practice Location Address
First Line	:	2432 N LINDEN PL APT 108
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-2835
Country	:	US
Telephone Number	:	773-276-2801
Fax Number	:

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

Provider Enumeration Date	:	10/20/2015
Last Update Date	:	10/20/2015

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Directions to “ SAMARA REIGH LAC” Practice Location

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