Provider Demographics
NPI:1841362407
Name:PRYOR, REED A (DC)
Entity type:Individual
Prefix:MR
First Name:REED
Middle Name:A
Last Name:PRYOR
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 1:1955 LAPORTE RD
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-2741
Mailing Address - Country:US
Mailing Address - Phone:319-232-2166
Mailing Address - Fax:319-232-0844
Practice Address - Street 1:1955 LAPORTE RD
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-2741
Practice Address - Country:US
Practice Address - Phone:319-232-2166
Practice Address - Fax:319-232-0844
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05697111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
58472OtherBCBS
IA0102582Medicaid
12100Medicare ID - Type Unspecified