Provider Demographics
NPI:1952500217
Name:JODY REID ENTERPRISES, PA
Entity Type:Organization
Organization Name:JODY REID ENTERPRISES, PA
Other - Org Name:BACK IN MOTION CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JODY
Authorized Official - Middle Name:D
Authorized Official - Last Name:REID
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:432-267-2225
Mailing Address - Street 1:1113 SOUTH SCURRY
Mailing Address - Street 2:
Mailing Address - City:BIG SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:79720-0000
Mailing Address - Country:US
Mailing Address - Phone:432-267-2225
Mailing Address - Fax:432-267-2228
Practice Address - Street 1:1113 SOUTH SCURRY
Practice Address - Street 2:
Practice Address - City:BIG SPRING
Practice Address - State:TX
Practice Address - Zip Code:79720
Practice Address - Country:US
Practice Address - Phone:432-267-2225
Practice Address - Fax:432-267-2228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-16
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6107111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX43PVOtherBCBS GROUP
TX00Y379Medicare PIN