Provider Demographics
NPI:1245326990
Name:REED, PATRICK GERALD (DC)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:GERALD
Last Name:REED
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:PO BOX 1214
Mailing Address - Street 2:
Mailing Address - City:BUNNELL
Mailing Address - State:FL
Mailing Address - Zip Code:32110-1214
Mailing Address - Country:US
Mailing Address - Phone:386-437-9990
Mailing Address - Fax:386-437-9990
Practice Address - Street 1:4601 EAST HIGHWAY 100
Practice Address - Street 2:SUITE G4
Practice Address - City:BUNNELL
Practice Address - State:FL
Practice Address - Zip Code:32110
Practice Address - Country:US
Practice Address - Phone:386-437-9990
Practice Address - Fax:386-437-9990
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8254111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381469600Medicaid
FL381469600Medicaid
U76892Medicare UPIN