Provider Demographics
NPI:1750866976
Name:DAVIDSON, REID THOMAS (DC)
Entity Type:Individual
Prefix:DR
First Name:REID
Middle Name:THOMAS
Last Name:DAVIDSON
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 1:19365 SW 65TH AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-9196
Mailing Address - Country:US
Mailing Address - Phone:503-486-5199
Mailing Address - Fax:503-486-5190
Practice Address - Street 1:19355 SW MOHAVE CT STE 100
Practice Address - Street 2:
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-8631
Practice Address - Country:US
Practice Address - Phone:503-486-5199
Practice Address - Fax:503-486-5190
Is Sole Proprietor?:No
Enumeration Date:2018-10-03
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5933111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1801059753OtherNOT CREDENTIALED WITH MEDICARE