Provider Demographics
NPI:1336175314
Name:REID, GARY M (DC)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:M
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 1:4002 DRY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-9716
Mailing Address - Country:US
Mailing Address - Phone:541-857-9160
Mailing Address - Fax:
Practice Address - Street 1:2009 AERO WAY
Practice Address - Street 2:STE. 101
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-9822
Practice Address - Country:US
Practice Address - Phone:541-770-7471
Practice Address - Fax:541-732-1466
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27-3001111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR120493Medicare ID - Type Unspecified
ORU53621Medicare UPIN