Provider Demographics
NPI:1205911294
Name:REID, JOHN DAVID (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DAVID
Last Name:REID
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 1:493 37TH ST NE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55906-5403
Mailing Address - Country:US
Mailing Address - Phone:507-281-4040
Mailing Address - Fax:
Practice Address - Street 1:493 37TH ST NE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55906-5403
Practice Address - Country:US
Practice Address - Phone:507-281-4040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1420111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN359000296Medicare ID - Type UnspecifiedPROVIDER ID
MNT70831Medicare UPIN