Provider Demographics
NPI:1619141678
Name:REEDER CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:REEDER CHIROPRACTIC, P.C.
Other - Org Name:N/A
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:REEDER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:719-384-2225
Mailing Address - Street 1:305 RATON AVE
Mailing Address - Street 2:
Mailing Address - City:LA JUNTA
Mailing Address - State:CO
Mailing Address - Zip Code:81050-1637
Mailing Address - Country:US
Mailing Address - Phone:719-384-2225
Mailing Address - Fax:719-384-2260
Practice Address - Street 1:305 RATON AVE
Practice Address - Street 2:
Practice Address - City:LA JUNTA
Practice Address - State:CO
Practice Address - Zip Code:81050-1637
Practice Address - Country:US
Practice Address - Phone:719-384-2225
Practice Address - Fax:719-384-2260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-21
Last Update Date:2008-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4251111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1649334848OtherINDIVIDUAL NPI