Provider Demographics
NPI:1144570755
Name:REID CHIROPRACTIC CLINIC PC
Entity Type:Organization
Organization Name:REID CHIROPRACTIC CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:REID
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-828-8300
Mailing Address - Street 1:5877 LIVERNOIS RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-3100
Mailing Address - Country:US
Mailing Address - Phone:248-828-8300
Mailing Address - Fax:248-828-9460
Practice Address - Street 1:5877 LIVERNOIS RD
Practice Address - Street 2:SUITE 104
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48098-3100
Practice Address - Country:US
Practice Address - Phone:248-828-8300
Practice Address - Fax:248-828-9460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICR004874111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F35222OtherBLUE CROSS
MICR004874Medicare PIN