Provider Demographics
NPI:1770619892
Name:REEVES, PHILIP W (DC)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:W
Last Name:REEVES
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 567
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-0567
Mailing Address - Country:US
Mailing Address - Phone:541-278-2225
Mailing Address - Fax:541-276-1888
Practice Address - Street 1:310 SE 2ND ST
Practice Address - Street 2:SUITE 201
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-2263
Practice Address - Country:US
Practice Address - Phone:541-278-2225
Practice Address - Fax:541-276-1888
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27 2535111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORU27324Medicare UPIN
R0000QGFSJMedicare ID - Type Unspecified