Provider Demographics
NPI:1518150390
Name:REED, JAMIE DALLAS (DC)
Entity Type:Individual
Prefix:MR
First Name:JAMIE
Middle Name:DALLAS
Last Name:REED
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:RR 1 BOX 458
Mailing Address - Street 2:
Mailing Address - City:SHAMOKIN
Mailing Address - State:PA
Mailing Address - Zip Code:17872-9721
Mailing Address - Country:US
Mailing Address - Phone:570-797-1000
Mailing Address - Fax:570-797-4977
Practice Address - Street 1:RR 1 BOX 458
Practice Address - Street 2:
Practice Address - City:SHAMOKIN
Practice Address - State:PA
Practice Address - Zip Code:17872-9721
Practice Address - Country:US
Practice Address - Phone:570-797-1000
Practice Address - Fax:570-797-4977
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC008791111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA080164SUPMedicare PIN