Provider Demographics
NPI:1366534364
Name:REACH, VICKI SUE (DC)
Entity type:Individual
Prefix:DR
First Name:VICKI
Middle Name:SUE
Last Name:REACH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12802 N CAVE CREEK RD
Mailing Address - Street 2:STE B
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-5825
Mailing Address - Country:US
Mailing Address - Phone:602-867-4210
Mailing Address - Fax:602-867-7600
Practice Address - Street 1:12802 N CAVE CREEK RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-5825
Practice Address - Country:US
Practice Address - Phone:602-867-4210
Practice Address - Fax:602-867-7600
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2017-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2060111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0234000OtherBLUE CROSS BLUE SHIELD
AZ35WCHLL06Medicare ID - Type Unspecified
AZ28070189Medicare UPIN