Provider Demographics
NPI:1164627634
Name:CLELAND-REID, CAROLYN ALICE (DC)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:ALICE
Last Name:CLELAND-REID
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:
Other - Last Name:REID
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:1540 MONUMENT RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-7332
Mailing Address - Country:US
Mailing Address - Phone:904-646-4222
Mailing Address - Fax:904-646-4227
Practice Address - Street 1:1540 MONUMENT RD
Practice Address - Street 2:SUITE 1
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-7332
Practice Address - Country:US
Practice Address - Phone:904-646-4222
Practice Address - Fax:904-646-4227
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-15
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7379111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition