Healthcare Provider Details

I. General information

NPI: 1679619894
Provider Name (Legal Business Name): REED R NELSON DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1390 ROUTE 286
EXPORT PA
15632-1947
US

IV. Provider business mailing address

1390 ROUTE 286
EXPORT PA
15632-1947
US

V. Phone/Fax

Practice location:
  • Phone: 724-325-2112
  • Fax: 724-325-2111
Mailing address:
  • Phone: 724-325-2112
  • Fax: 724-325-2111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC005139L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: