Provider Demographics
NPI:1104181007
Name:PATRICK REED DC PA
Entity Type:Organization
Organization Name:PATRICK REED DC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:REED
Authorized Official - Last Name:GERALD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:386-437-9990
Mailing Address - Street 1:PO BOX 1214
Mailing Address - Street 2:
Mailing Address - City:BUNNELL
Mailing Address - State:FL
Mailing Address - Zip Code:32110-1214
Mailing Address - Country:US
Mailing Address - Phone:386-437-9990
Mailing Address - Fax:386-437-9990
Practice Address - Street 1:4601 E MOODY BLVD
Practice Address - Street 2:G4
Practice Address - City:BUNNELL
Practice Address - State:FL
Practice Address - Zip Code:32110-9017
Practice Address - Country:US
Practice Address - Phone:386-437-9990
Practice Address - Fax:386-437-9990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-07
Last Update Date:2012-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8254111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381469600Medicaid
FL381469600Medicaid
FL70304Medicare PIN