Provider Demographics
NPI:1134621014
Name:REED, JAE LESLIE (DC)
Entity type:Individual
Prefix:
First Name:JAE
Middle Name:LESLIE
Last Name:REED
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LESLIE
Other - Last Name:REED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:110 GOUGH ST STE 201A
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-5968
Mailing Address - Country:US
Mailing Address - Phone:415-864-2975
Mailing Address - Fax:
Practice Address - Street 1:110 GOUGH ST STE 201A
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-5968
Practice Address - Country:US
Practice Address - Phone:415-864-2975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-06
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC33916111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty