Provider Demographics
NPI:1649334848
Name:REEDER, JEFFERY DALE (DC)
Entity type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:DALE
Last Name:REEDER
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 1:305 RATON AVE
Mailing Address - Street 2:
Mailing Address - City:LA JUNTA
Mailing Address - State:CO
Mailing Address - Zip Code:81050-1637
Mailing Address - Country:US
Mailing Address - Phone:719-384-2225
Mailing Address - Fax:719-384-2260
Practice Address - Street 1:305 RATON AVE
Practice Address - Street 2:
Practice Address - City:LA JUNTA
Practice Address - State:CO
Practice Address - Zip Code:81050-1637
Practice Address - Country:US
Practice Address - Phone:719-384-2225
Practice Address - Fax:719-384-2260
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4251111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO49833Medicare ID - Type Unspecified