Provider Demographics
NPI:1801075312
Name:REEDER CHIROPRACTIC, P.A.
Entity type:Organization
Organization Name:REEDER CHIROPRACTIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:REEDER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:843-871-5055
Mailing Address - Street 1:112 W DOTY AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-6085
Mailing Address - Country:US
Mailing Address - Phone:843-871-5055
Mailing Address - Fax:843-871-5051
Practice Address - Street 1:112 W DOTY AVE
Practice Address - Street 2:SUITE B
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-6085
Practice Address - Country:US
Practice Address - Phone:843-871-5055
Practice Address - Fax:843-871-5051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC1246111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC3166Medicare PIN