Healthcare Provider Details

I. General information

NPI: 1083915953
Provider Name (Legal Business Name): JAMIE REED D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2010
Last Update Date: 07/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 N LA CIENEGA BLVD STE 200
BEVERLY HILLS CA
90211
US

IV. Provider business mailing address

1101 N CARRIER PKWY E
GRAND PRAIRIE TX
75050-3382
US

V. Phone/Fax

Practice location:
  • Phone: 310-657-9353
  • Fax: 310-657-9367
Mailing address:
  • Phone: 972-237-1482
  • Fax: 972-237-5660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP126697
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95008811
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number11461
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: