Provider Demographics
NPI:1417161837
Name:GARY M REID DCPC
Entity Type:Organization
Organization Name:GARY M REID DCPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:M
Authorized Official - Last Name:REID
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:541-770-7471
Mailing Address - Street 1:2009 AERO WAY
Mailing Address - Street 2:101
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-9822
Mailing Address - Country:US
Mailing Address - Phone:541-770-7471
Mailing Address - Fax:541-732-1466
Practice Address - Street 1:2009 AERO WAY
Practice Address - Street 2:101
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-9822
Practice Address - Country:US
Practice Address - Phone:541-770-7471
Practice Address - Fax:541-732-1466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27 3001111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty