Provider Demographics
NPI:1770156937
Name:REED, BLAKE (DC)
Entity type:Individual
Prefix:
First Name:BLAKE
Middle Name:
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 1:2013 JOHNSON RD STE D
Mailing Address - Street 2:
Mailing Address - City:GRANITE CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62040-3980
Mailing Address - Country:US
Mailing Address - Phone:618-931-2050
Mailing Address - Fax:618-931-2048
Practice Address - Street 1:2013 JOHNSON RD STE D
Practice Address - Street 2:
Practice Address - City:GRANITE CITY
Practice Address - State:IL
Practice Address - Zip Code:62040-3980
Practice Address - Country:US
Practice Address - Phone:618-931-2050
Practice Address - Fax:618-931-2048
Is Sole Proprietor?:No
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038013743111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation