Healthcare Provider Details

I. General information

NPI: 1164700357
Provider Name (Legal Business Name): JAMEELAH REID D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2011
Last Update Date: 07/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6310 LBJ FWY 218
DALLAS TX
75240-6401
US

IV. Provider business mailing address

1240 GLENWWOD DR.
IRVING TX
75060
US

V. Phone/Fax

Practice location:
  • Phone: 972-701-8181
  • Fax:
Mailing address:
  • Phone: 713-319-8866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number11012
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: