Provider Demographics
NPI:1669815692
Name:REED, JENNIFER CHARESE (DC)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:CHARESE
Last Name:REED
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 1:403 OVERLAND AVE
Mailing Address - Street 2:STE A
Mailing Address - City:KENAI
Mailing Address - State:AK
Mailing Address - Zip Code:99611-8050
Mailing Address - Country:US
Mailing Address - Phone:907-395-4466
Mailing Address - Fax:907-395-4460
Practice Address - Street 1:4000 W DIMOND BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99502-1475
Practice Address - Country:US
Practice Address - Phone:907-243-0660
Practice Address - Fax:907-248-5481
Is Sole Proprietor?:No
Enumeration Date:2013-04-09
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TX12347111N00000X
AK605111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX383219Medicare PIN