Provider Demographics
NPI:1477748077
Name:REED, CHARLES JR (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:
Last Name:REED
Suffix:JR
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 1:11081 ANTIOCH
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210
Mailing Address - Country:US
Mailing Address - Phone:913-649-4045
Mailing Address - Fax:913-649-8407
Practice Address - Street 1:216 E 7TH ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:NE
Practice Address - Zip Code:68467-3023
Practice Address - Country:US
Practice Address - Phone:402-362-7092
Practice Address - Fax:402-362-7195
Is Sole Proprietor?:No
Enumeration Date:2007-09-07
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1233111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE279421Medicare PIN
NEU79004Medicare UPIN