Provider Demographics
NPI:1689898959
Name:REED, JACQUELYN (DC)
Entity Type:Individual
Prefix:DR
First Name:JACQUELYN
Middle Name:
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 1:2601 SUTTON BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63143-2117
Mailing Address - Country:US
Mailing Address - Phone:314-781-9400
Mailing Address - Fax:314-781-9880
Practice Address - Street 1:2601 SUTTON BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63143-2117
Practice Address - Country:US
Practice Address - Phone:314-781-9400
Practice Address - Fax:314-781-9880
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000164555111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO150938OtherBLUE CROSS BLUE SHIELD
MO29773OtherGHP