Provider Demographics
NPI:1376692343
Name:KORVAH-REED, DEDDEH A (DC)
Entity Type:Individual
Prefix:
First Name:DEDDEH
Middle Name:A
Last Name:KORVAH-REED
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 1:67 PARSONS AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-3978
Mailing Address - Country:US
Mailing Address - Phone:614-222-0019
Mailing Address - Fax:614-222-0021
Practice Address - Street 1:67 PARSONS AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-3978
Practice Address - Country:US
Practice Address - Phone:614-222-0019
Practice Address - Fax:614-222-0021
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3769111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2805503Medicaid
OH2805503Medicaid