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General NPI Number Information
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NPI Number | 1104181007
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Entity Type | Organization
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Legal Business Name | PATRICK REED DC PA
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Dates
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Enumeration Date | 07/07/2012
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Last Update Date | 07/07/2012
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Provider Practice Location Address
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Address Line | 4601 E MOODY BLVD G4
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City | BUNNELL
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State | FL
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Zip | 32110-9017
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Country | US
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Telephone | 386-437-9990
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Fax | 386-437-9990
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Provider Business Mailing Address
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Address Line | PO BOX 1214
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City | BUNNELL
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State | FL
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Zip | 32110-1214
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Country | US
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Telephone | 386-437-9990
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Fax | 386-437-9990
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Authorized Official
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Title or Position | OWNER
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Name | DR. PATRICK REED GERALD
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Credential | DC
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Telephone | 386-437-9990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH8254
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License Number State | FL
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