Provider Demographics
NPI:1275835902
Name:REID, KATJA SARA MICHELLE (DC)
Entity Type:Individual
Prefix:DR
First Name:KATJA
Middle Name:SARA MICHELLE
Last Name:REID
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 1:712 N 24TH ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-6408
Mailing Address - Country:US
Mailing Address - Phone:541-231-9790
Mailing Address - Fax:
Practice Address - Street 1:9173 ATLEE RD
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-2506
Practice Address - Country:US
Practice Address - Phone:804-730-7010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-01
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5966111N00000X
VA0104557624111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor