Provider Demographics
NPI:1376607994
Name:REID, CHARLES ALFRED (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ALFRED
Last Name:REID
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5877 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
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004874111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950F352220OtherBLUECROSS BLUESHIELD OF MICHIGAN
MI950F352220OtherBLUECROSS BLUESHIELD OF MICHIGAN