Provider Demographics
NPI:1952336349
Name:REED, ROBERT DOUGLAS (DC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:DOUGLAS
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 1:2112 LYNDALE AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55405-3026
Mailing Address - Country:US
Mailing Address - Phone:612-874-1313
Mailing Address - Fax:612-874-6767
Practice Address - Street 1:2112 LYNDALE AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55405-3026
Practice Address - Country:US
Practice Address - Phone:612-874-1313
Practice Address - Fax:612-874-6767
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3583111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN350003449Medicare ID - Type UnspecifiedMEDICARE NUMBER
MNU69108Medicare UPIN
MN350003449Medicare PIN