Provider Demographics
NPI:1508991084
Name:REID, LESLIE ANNE (DC)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:ANNE
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 1:16075 MANCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:ELLISVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63011-2103
Mailing Address - Country:US
Mailing Address - Phone:636-256-0880
Mailing Address - Fax:636-256-9153
Practice Address - Street 1:16075 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:ELLISVILLE
Practice Address - State:MO
Practice Address - Zip Code:63011-2103
Practice Address - Country:US
Practice Address - Phone:636-256-0880
Practice Address - Fax:636-256-9153
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001025911111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO653079OtherUHC PROVIDER #
MO200557644OtherFEDERAL TAX ID #
MO465372OtherHEALTHLINK PROV #
MO149546OtherBLUE CROSS PROV #
MOP00338527OtherMEDICARE RR PROV #
MOP00338527OtherMEDICARE RR PROV #
MOU87002Medicare UPIN