Provider Demographics
NPI:1922277300
Name:REID, ROBERT STEWART (D C)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:STEWART
Last Name:REID
Suffix:
Gender:M
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 812
Mailing Address - Street 2:304 N WESTBERRY STREET
Mailing Address - City:SYLVESTER
Mailing Address - State:GA
Mailing Address - Zip Code:31791-0812
Mailing Address - Country:US
Mailing Address - Phone:229-776-4697
Mailing Address - Fax:229-776-1494
Practice Address - Street 1:304 N WESTBERRY ST
Practice Address - Street 2:
Practice Address - City:SYLVESTER
Practice Address - State:GA
Practice Address - Zip Code:31791-2125
Practice Address - Country:US
Practice Address - Phone:229-776-4697
Practice Address - Fax:229-776-1494
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-29
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR002855111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCBLFOtherMEDICARE PROVIDER #
GA35ZCBLFOtherMEDICARE PROVIDER #