Provider Demographics
NPI:1578533287
Name:REED, CARL BENTON (DC)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:BENTON
Last Name:REED
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:CARL
Other - Middle Name:B
Other - Last Name:REED
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 481
Mailing Address - Street 2:
Mailing Address - City:ALTUS
Mailing Address - State:OK
Mailing Address - Zip Code:73522-0481
Mailing Address - Country:US
Mailing Address - Phone:580-482-2313
Mailing Address - Fax:580-482-2356
Practice Address - Street 1:112 N JULIAN ST
Practice Address - Street 2:
Practice Address - City:ALTUS
Practice Address - State:OK
Practice Address - Zip Code:73521-3950
Practice Address - Country:US
Practice Address - Phone:580-482-2313
Practice Address - Fax:580-482-2356
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1345111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKQDBGRMedicare PIN